La Cuarterona

Name:      
Date:      

Place your cursor in gray boxes to fill out worksheet. Remember to save your answers.

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How often does your partner:
1. Criticize you for your appearance(weight, dress, hair, etc.)?
2. Embarrass you in front of others by putting you down?
3. Blame you or others for his or her mistakes?
4. Curse at you, shout at you, say mean things, insult or mockyou?
5. Demonstrate uncontrollable anger?
6. Criticize your friends, family, or others who are close to you?
7. Threaten to leave you if you don’t behave in a certain way?
8. Manipulateyou to prevent you from spending time with friends or family?
9. Express jealousy, distrust, and anger when you spend time with other people?
10. Make all the significant decisions in yourrelationship?
11. Intimidate or threaten you, making you fearful or anxious?
12. Make threats to harm others you care about?
13. Control your telephone calls, listen in on your messages, or readyour e-mail?
14. Punch, hit, or slap you?
15. Gossip about you to turn others against you or make them think bad things
about you?
16. Make you feel guilty about something?
17. Use moneyor possessions to control you?
18. Force you to have sex or perform sexual acts that make you feel
uncomfortable?
19. Threaten to kill himself or herself if you leave?
20. Follow you, callto check on you, or demonstrate a constant obsession with what
you are doing?

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How often do you:
1. Drink more than 1 or 2 drinks while out with friends or at a party?
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2. Leave your drinks unattended while you get up to dance or go to the bathroom?
3. Accept drinks from strangers while out at a bar or party?
4.Leave parties with people you barely know or just met?
5. Walk alone in poorly lit or unfamiliar places?
6. Open the door to strangers?
7. Leave your car or home door unlocked?

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How...