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ACE Score

 Instructions 

Please complete the following survey.  

Please note, all answers apply before you turned 18 years of age. 

This question requires a valid date format of MM/DD/YYYY.
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3.

Did a parent or adult in your home ever swear at you, insult you, or put you down?

*This question is required.
4.

Did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way?

*This question is required.
5.

Did you experience unwanted sexual contact (such as fondling or oral/anal/vaginal intercourse/penetration)?

*This question is required.
6.

Did you feel that no one in your family loved you or thought you were special?

*This question is required.
7. Did you feel that you didn’t have enough to eat, had to wear dirty clothes, or had no one to protect or take care of you? *This question is required.
8.

Did you lose a parent through divorce, abandonment, death, or other reason?

*This question is required.
9.

Did your parents or adults in your home ever hit, punch, beat, or threaten to harm each other?

*This question is required.
10.

Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

*This question is required.
11.

Was a household member depressed or mentally ill, or did a household member attempt suicide? 

*This question is required.
12. Did you live with anyone who went to jail or prison? *This question is required.
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