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Dating After Sexual or Domestic Violence Survey
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1.
2What is your age?
(Required.)
18-24
25-34
35-44
45-54
55-+
*
2.
What is your race?
(Required.)
White
Black
Asian
Hispanic
Other
3.
Gender: How do you identify?
Man
Non-binary
Woman
Prefer to self-describe, below
Self-describe:
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4.
Do you believe that your previous experience of sexual or domestic violence has affected your current or past relationships?
(Required.)
Yes
No
Not sure
*
5.
How comfortable are you discussing consent with your partner?
(Required.)
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
*
6.
Have you received any education or support regarding consent in dating relationships?
(Required.)
Yes
No
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7.
Do you believe that education and awareness about consent can prevent sexual or domestic violence in dating relationships?
(Required.)
Yes
No
Not sure
8.
What resources or support do you think are important for survivors of sexual or domestic violence in the context of dating?
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9.
Did you seek professional counseling or therapy after your experience with sexual or domestic violence?
(Required.)
Yes
No
*
10.
How long did you wait before you started dating after the incident?
(Required.)
Less than 6 months
6 months to a year
1-2 years
More than 2 years
I haven't started dating again
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11.
Did you disclose your experience with your new partner(s)?
(Required.)
Yes
No
*
12.
If you disclosed, at what point in the relationship did you typically share this information?
(Required.)
At the beginning
After a few dates
Once we became exclusive
Only if the topic came up
Other (please specify)
*
13.
How did your partner(s) generally react upon learning about your past?
(Required.)
Supportive
Indifferent
Uncomfortable
Disbelieving
Overprotective
Other (please specify)
*
14.
Did concerns related to your past experience impact your decision on when or if to become physically intimate with your new partner?
(Required.)
Yes
No
15.
What are the primary challenges you face(d) when dating after your experience with sexual or domestic violence?
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16.
Have you joined any support groups or communities related to your experience?
(Required.)
Yes
No
I am considering it
