Childhood trauma
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1. Untitled Page

1. Have you ever been through a traumatic event as a child?

Have you ever been through a traumatic event as a child? yes

no

2. At what age did this traumatic event happen?

At what age did this traumatic event happen? 3

4

5

6

7

8

9

10

12

13

15

16

3. Where did this traumatic event happen?

Where did this traumatic event happen? Home

School

hospital

daycare

with a babysitter

doctors office

plane

train

car

bus

subway

boat

4. What type of traumatic event was it?

What type of traumatic event was it? medical procedure

accident

mental abuse

physical abuse

rape

emotional abuse

natural disaster

bully

police action

mugging

drugs

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