Brief Relationship Risk Assessment

1. Demographics

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20% of survey complete.

Question Title

* 1. What is your gender?

Female

Male

Other (specify)

Question Title

* 2. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

Question Title

* 3. Are you now married, widowed, divorced, separated, or have you never been married?

Married

Widowed

Divorced

Separated

Never married

Question Title

* 4. How long have you been married or together?

Question Title

* 5. How many times have you been married?

Question Title

* 6. How many people currently live in your household?