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Ace Questionnaire PDF  Form

Ace Questionnaire PDF Form

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The Adverse Childhood Experiences questionnaire is composed of ten questions. For each question, answer yes or no. Keep count of each time you answer yes. While you were growing up, during the first 18 years of life: Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? or act in a way that made you afraid that you might be physically hurt? While you were growing up, during the first 18 years of life: Did a parent or other adult in the household often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured? While you were growing up, during the first 18 years of life: Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? Or try to or actually have oral, , or vaginal sex with you? While you were growing up, during the first 18 years of life: Did you often feel that no one in your family loved you or thought you wer

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