Self Assessment

Please select how often your partner did each of these things in the past 12 months?

(Number of assessment: 4606)

1: Has your partner ever physically hurt you in the past 12 months? *

3: Has your partner ever threatened to harm you in the past 12 months? *

4: Has your partner ever screamed or cursed at you in the past 12 months? *

5: Has your partner ever forced you to have sexual activities in the past 12 months? *

Basic Information

8: Sex *

Male

Female

Transgender

Others (please specify)

9: Family Monthly Income *

Source:
Chan C.C., Chan Y. C., Au A., Cheung G.O.C. (2010). Reliability and validity of the "extended - hurt, insult, threaten, scream" (e-hits) screening tool in detecting intimate partner violence in hospital emergency departments in Hong Kong. Hong Kong Journal of Emergency Medicine, 17(2), 109-117

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