Where should we email your results?

Full Name *

Email *

Phone

1. Have you ever experienced an event that felt life-threatening or deeply stressful? *

No, not that I can remember.

Yes, but I don’t think about it much.

Yes, and I think about it often.

2. Do you find yourself reacting strongly (emotionally or physically) to reminders of past events? *

Rarely or never.

Occasionally.

Yes, often.

3. When thinking about your childhood, how do you feel about your caregivers or family? *

I feel mostly positive and supported.

It’s complicated; I feel both positive and negative.

I feel unsupported or hurt by them.

4. Do you avoid certain places, people, or situations because they remind you of past events? *

No, not really.

Sometimes.

Yes, frequently.

5. Have you experienced difficulties forming or maintaining healthy relationships? *

No, I usually do well in relationships.

Occasionally.

Yes, it’s been a struggle.

6. When faced with conflict or stress, how do you typically respond? *

I handle it calmly and effectively.

I feel anxious but can manage most of the time.

I feel overwhelmed and shut down or lash out.

7. Have you experienced the following types of trauma (check any that apply) (optional):

Physical trauma (e.g., accidents, injuries, assault).

Emotional trauma (e.g., bullying, emotional abuse, neglect).

Relational trauma (e.g., toxic relationships, abandonment).

Other (e.g., war, natural disasters, systemic oppression).