Ways Your Partner May Have Hurt You

WAYS YOUR PARTNER MAY HAVE HURT YOU

Please read each set of questions and circle yes or no to each question.

HAS YOUR PARTNER EVER:

Called you a name or made fun of you? YES NO

Ignored you? YES NO

Told you that you were a bad parent? YES NO

Refused to do housework or childcare? YES NO

Made you ask for permission to use personal property? YES NO

Accused you of paying too much attention to someone or something else? YES NO

Made you beg for forgiveness? YES NO

Demanded to be waited upon? YES NO

Intimidated you through his tone of voice? YES NO

Gave you angry looks or stares? YES NO

Put down your family or friends? YES NO

Put down your physical appearance? YES NO

Tried to change your physical appearance? YES NO

Not taken advantage of any of your strengths or accomplishments? YES NO

Told you that no one else would want you? YES NO

Accused you of cheating on the relationship? YES NO

Harassed you for information on past relationship? YES NO

Put down or yelled at your children in front of you? YES NO

Threatened to physically take your children away? YES NO

Threatened to make you lose custody of the children? YES NO

CONFINEMENT AND CONTROL ISSUES:

The following items have to do with incidents in which your partner may have attempted or succeeded in confining you to your home or controlling whom you saw or spoke to.

HAS YOUR PARTNER EVER:

Bodily confined or held you against your will? YES NO

Prevented you from leaving a room or your home? YES NO

Stopped you from going to school or work? YES NO

Prevented you from seeing family or friends? YES NO

Denied you the right to receive health care? YES NO

Prevented you from taking any medications? YES NO

Listened to your phone calls? YES NO

Disabled your telephone? YES NO

Opened your mail? YES NO

Had you followed? YES NO

Checked the mileage on your car? YES NO

Taken away your keys? YES NO

Phoned you repeatedly at work? YES NO

Got you fired from work? YES NO

Controlled your food intake? YES NO

Put you on a monetary allowance? YES NO

Made you ask or beg for money? YES NO

Made you explain how money was spent? YES NO

Got angry if you were late getting home? YES NO

Insisted on having the final say in all decisions? YES NO

Made you use drugs or alcohol against your will? YES NO

THREAT OF PHYSICAL VIOLENCE

The following items have to do with behavior your partner may have used to threaten or scare you.

HAS YOUR PARTNER EVER:

Threatened to hit you? YES NO

Threatened to throw objects at you? YES NO

Threatened to use a weapon against you? YES NO

Threatened to kill you? YES NO

Thrown or smashed objects in your presence? YES NO

Destroyed your personal property? YES NO

Hit walls or pounded a fist when angry at you? YES NO

Driven carelessly when you were in the car? YES NO

Abused family pets to hurt you? YES NO

Punished your children when he/she was angry at you? YES NO

Threatened to harm or kill your family and/or friends? YES NO

Threatened to harm or kill your children? YES NO

Threatened to harm or kill himself/herself? YES NO

Hurt or mutilated himself/herself to scare you? YES NO

Tried to run you over with a vehicle? YES NO

PHYSICAL VIOLENCE

The following items have to do with incidents in which physical violence may have occurred against you.

HAS YOUR PARTNER EVER:

Slapped you? YES NO

Pushed or shoved you? YES NO

Thrown you around (into walls, furniture, onto floor)? YES NO

Hit you with an open hand? YES NO

Hit you with a fist? YES NO

Hit you with an object? YES NO

Scratched you? YES NO

Pinched you? YES NO

Pulled your hair? YES NO

Grabbed you? YES NO

Spit on you? YES NO

Bit you? YES NO

Kicked you? YES NO

Burned you? YES NO

Injured you by holding or squeezing you too tightly? YES NO

Choked or tried to strangle you? YES NO

Used a weapon against you (stabbed, shot, etc.)? YES NO

Run you over with a vehicle? YES NO

Physically hurt you when you were pregnant? YES NO

Physically hurt you while he/she was under the influence of alcohol or drugs? YES NO

SEXUAL ABUSE

The following items are concerned with sexual abuse. Many women do not realize sexual abuse has occurred during their relationships until someone points out specific things that can happen between men and women that are physically and/or emotionally harmful to women.

HAS YOUR PARTNER EVER:

Called you negative sexual names like "frigid" or "whore"? YES NO

Forced or pressured you to participate in sex with him against your will? YES NO

Pressured you to participate in a sexual activity that hurt you? YES NO

Forced you to have sex in the presence of others? YES NO

Used threatening objects or weapons during sex? YES NO

Prevented you from using birth control? YES NO

Lied about his use of birth control? YES NO

Withheld information about whether he had been exposed to a sexually transmitted disease or the HIV virus? YES NO

Physically attacked the sexual parts of your body (breasts or genitalia)? YES NO

Pressured you to get pregnant against your will? YES NO

Call today to schedule an appointment with Melissa Graham-Hurd.
Ohio Divorce Attorney

Melissa Graham-Hurd
333 South Main St.
Suite 301
Akron, Ohio 44308
330-996-4099

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