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Adverse Childhood Experiences (ACES) Survey

We discussed the ACE study and how adversity in childhood affects our mental, physical, and emotional health throughout our lives. Please know that this questionnaire is not required and there will be no penalty to you if you choose not to complete it.

If you do choose to complete this questionnaire, please note that it is completely anonymous. This information will be used only for statistical data and will not be linked to you in any way.
1.Did you feel that you did not have enough to eat, had to wear dirty clothes, or had no one to protect or take care of you?
2.Did you lose a parent through divorce, abandonment, death, or other reason?
3.Did you live with anyone who was depressed, mentally ill, or attempted suicide?
4.Did you live with anyone who had a problem with drinking or using drugs, including prescription drugs?
5.Did the adults in your home ever hit, punch, beat, or threaten to harm each other?
6.Did you live with anyone who went to jail or prison?
7.Did a parent or adult in your home ever swear at you, insult you, or put you down?
8.Did a parent or adult in your home ever hit, beat, kick, or otherwise physically harm you?
9.Did you feel that no one in your family loved you or thought you were special?
10.Did you experience unwanted sexual contact (such as fondling and/or oral/anal/vaginal intercourse or penetration)