Questionnaire

What is your relationship like?

Are there times when your partner:

 

1. Hurts your feelings? (By insulting you, making fun of you in front of your family or your friends, or ignoring you)

 

2. Threatens or intimidates you or someone you care about?

 

3. Insists on making the decisions in your relationship, without considering your opinion?

 

4. Pushes or slaps you?

 

5. Gets jealous or stops you from doing activities or seeing your friends?

 

6. Posts information about you or pictures online that you don’t want others to see?

 

7. Accesses your private e-mail, Facebook or other social media accounts without your permission?

 

8. Pressures you to consent to sexual activities you are not comfortable with?

 

9. Insists that you use drugs or drink alcohol when you are together?

 

10. Keeps on phoning or texting you to ask you where you are?

 

11. Demands you dress according to his tastes?

 

12. Behaves and/or reacts in a way that scares you and makes you feel uncomfortable to discuss things that are important to you with him?

 

 

 

 

Yes          No

 

 

 

If you answered “yes” to any of these questions, you may be in an abusive relationship.

 

 

 

Adapted from the brochure “Teens and Dating” published by New Brunswick’s Public Legal Education and Information Service in collaboration with Fredericton’s Sexual Assault Centre (2012).

 

For information or listening,
please contact us.

 

L'Escale MadaVic

P.O. Box 411, Edmundston (NB)  E3V 3L1

 

Phone: 506 739-6265

Fax: 506 735-5382

Contact us

For information or listening,
please contact us.

 

L'Escale MadaVic

P.O. Box 411, Edmundston (NB)  E3V 3L1

 

Phone: 506 739-6265

Fax: 506 735-5382

Contact us

24h Emergency Services

506 739-6265 oR 911

24h Emergency Services

506 739-6265 oR 911

Yes        No