This free survey is powered by
Create a Survey
Surveys
2016
October
D
Domestic Violence
Domestic Violence
0%
Exit Survey
Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
Have you ever been directly involved in domestic violence?
Yes
No
Do you know anyone, currently or in the past, involved in domestic violence?
Yes
No
Unsure
Other
Were you the abuser or the abused?
Abuser
Abused
Both
Both, but abused first
Both, but abuser first
Neither
In the situation, could you leave or were you bound by circumstances you couldn't change or control?
I could and did leave
I was a child and didn't know I could leave
I couldn't leave
I was a child and I sought help and left
I was the abuser
Doesn't apply to me
Other
Feel free to describe other here, if you wish.
Do you believe that alcohol or drugs played a part in the domestic violence you experienced or
Yes, both
No, neither
I feel alcohol did but not drugs
I feel drugs did but not alcohol
Unsure
Doesn't apply to me
What was the gender of the abuser?
Male
Female
Both
Unsure
Doesn't apply to me
Loading...
close
Loading...
Close
qprun1.questionpro.net