Anonymous Dating Questionnaire

1. What is your age group? *

2. What is your gender? *

Growing Up/Childhood

3. Growing Up, did you ever witness unhealthy or controlling behavior between adults in your home? *

4. As a child or teen, did anyone in your household make you feel afraid, controlled or unsafe? *

5. Did you learn about healthy relationships while growing up? *

Dating Experiences

6. Did you ever feel pressured or controlled by someone you were dating? *

7. Did you ever feel like you were isolated from friends, family or support systems? *

8. Did anyone you dated discourage you from social events, school activities, or spending time with supportive people? *

9. Did a dating partner ever check your phone, messages, or social media without your permission? *

10. During dating, did anyone ever insult, belittle, or put you down in a way that affected your confidence? *

11. Have you ever felt afraid to disagree with or upset a dating partner? *

Adult Relationships

12. Have you ever been in an adult relationship where your felt controlled, manipulated, or intimidated? *

13. Did a partner ever control your finances or prevent you from working? *

14. Did a partner ever isolate your from friends, family, or support systems? *

15. Did a partner ever use threats (emotional, physical, or financial) to get their way? *

16. Has a partner ever made you feel that your safety, or your children's safety was at risk? *

Emotional, Verbal & Psychological Behaviors

17. Has anyone (partner or family member) ever repeatedly criticized you, insulted you, or made you feel " less than"? *

18. Have you ever felt like you were "walking on eggshells" around a partner? *

19. Have you ever been blamed for things you didn't do or made to feel guilty for speaking up? *

20. Have you ever felt manipulated or "gaslit" , or made to question your memory, feelings, or sanity by your partner? *

Physical or Sexual Experiences

22. Have you ever been pressured or forced into sexual activity when you didn't want to? *

21. Have you ever experienced physical harm from a partner? *

Awareness & Support

23. At the time, did you recognize the behaviors as unhealthy or abusive? *

24. Did you ever reach out for help or support? *

If Other, Please Explain

26. What prevented you from reaching out, if you didn't?

Impact & Healing

27. Do you feel past experiences still affect you today? *

28. What has helped you most in healing or building healthy relationships? *

29. If you would like resources about healthy relationships, safety planning, or support organizations ,please click the link below. All contact information is kept confidential.

https://bit.ly/HHanonymousdatingsurvey

30. Is there anything you wish someone had taught you earlier about relationships or safety? *

31. Do you have any additional comments you'd like to share? *

If yes, please share your comments

Thank you for answering these questions. We appreciate your time.

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