Domestic Violence Survivors Survey

This survey is only for survivors of domestic violence (any type). Our goal is to learn more about DV survivors in order to create appropriate materials that support healing after abuse.  Your honest answers will help us provide the most robust materials available and we are truly grateful as we know that each time you revisit the abuse it is difficult. 

At the end of the survey there will be a place to add your email address if you would like to be on our email list OR if you would like to share your story in an upcoming book, our blog or on our social media channels. You are not required to provide this information! 

Thank you for taking the survey!

How long were you in an abusive relationship?

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* 1. How long were you in an abusive relationship?

From the time you made a commitment to your partner, when did you first realize you were in an abusive relationship?

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* 2. From the time you made a commitment to your partner, when did you first realize you were in an abusive relationship?

Which forms of abuse did you experience?

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* 3. Which forms of abuse did you experience?

Do you have children with your abuser?

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* 4. Do you have children with your abuser?

If yes, did any of your children witness or hear abusive behavior?

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* 5. If yes, did any of your children witness or hear abusive behavior?

Were you raised in a home where you witnessed or heard abuse?

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* 6. Were you raised in a home where you witnessed or heard abuse?

Was your abuser raised in a home where he/she witnessed or heard abuse

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* 7. Was your abuser raised in a home where he/she witnessed or heard abuse

Did any of your friends tell you, either during your relationship or afterwards, that they were concerned about you being abused?

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* 8. Did any of your friends tell you, either during your relationship or afterwards, that they were concerned about you being abused?

If so, how did you react to their comments of concern?

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* 9. If so, how did you react to their comments of concern?

If you stayed with your abuser once you realized you were being abused, what factors prevented you from leaving?

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* 10. If you stayed with your abuser once you realized you were being abused, what factors prevented you from leaving?

Did you ever leave and then return to your abuser?

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* 11. Did you ever leave and then return to your abuser?

Have you had more than 1 abusive relationship?

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* 12. Have you had more than 1 abusive relationship?

Rate your level of self-worth before your abusive relationship

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* 13. Rate your level of self-worth before your abusive relationship

Rate your level of self-worth after the first abusive incident

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* 14. Rate your level of self-worth after the first abusive incident

Rate your level of self-worth after you left your abuser

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* 15. Rate your level of self-worth after you left your abuser

Rate your level of self-worth today

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* 16. Rate your level of self-worth today

What steps have you taken to heal?

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* 17. What steps have you taken to heal?

If your self-worth was at a higher level, how would your life be different?

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* 18. If your self-worth was at a higher level, how would your life be different?

Which resources would you be likely to use if you felt they could improve your self-worth?

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* 19. Which resources would you be likely to use if you felt they could improve your self-worth?

Rank the top 3 ways you like to learn about opportunities to grow/heal

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* 20. Rank the top 3 ways you like to learn about opportunities to grow/heal

Do you learn best by...

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* 21. Do you learn best by...

What is your gender identity?

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* 22. What is your gender identity?

What is your age?

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* 23. What is your age?

Which race/ethnicity best describes you? (Please choose only one.)

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* 24. Which race/ethnicity best describes you? (Please choose only one.)

Which of the following best describes your current relationship status?

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* 25. Which of the following best describes your current relationship status?

Which of the following categories best describes your employment status?

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* 26. Which of the following categories best describes your employment status?

What is the highest level of school that you have completed?

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* 27. What is the highest level of school that you have completed?

Which of the following best describes your current job level?

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* 28. Which of the following best describes your current job level?

What is your first name?

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* 30. What is your first name?

At what email address would you like to be contacted?

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* 31. At what email address would you like to be contacted?

Are you willing to share your story of survival with others?

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* 32. Are you willing to share your story of survival with others?

Thank you for completing our survey!

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