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Please rate each question in terms of how acceptable it would be for you to ask every patient these questions at a routine visit

Your responses are anonymous

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* 1. Is your partner, or people at home, ever scared of you?

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* 2. Have you ever physically hurt someone you care about?

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* 3. Have you ever been so angry at home that you have hit someone, a wall or furniture?

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* 4. Is it very important to make sure no one takes advantage of you?

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* 5. Are you frustrated when people at home don’t appreciate what you do for them?

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* 6. Have you ever been concerned that you could not control your anger at home?

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* 7. Do you think people at home make an extra effort to avoid making you angry?

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* 8. Have you used force or the threat of force to settle a disagreement with your partner or someone you care about?

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* 9. Have you ever felt that you might need help with your anger?

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* 10. Have you had to respond with force when your partner or someone you care about has used force against you?

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* 11. Have you ever been reported to the police or other authorities after a violent incident?

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* 12. Has anyone else ever suggested that you might need help managing or controlling your anger?

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* 13. Do you have any comments about these questions?

*DO NOT INCLUDE ANY PERSONAL IDENTIFIERS HERE

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* 14. What is your sex?

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* 15. Years of practice:

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* 16. If you are willing to be contacted for participation in an anonymous qualitative interview regarding the screening questions, please provide your email below.

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