Healthy Relationships Pre-Survey

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* 1. What age category are you in?

Under 15

15-24

25-34

35-44

45-54

55-64

65+

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* 2. What are 3 forms of abuse?

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* 3. If a person is high on drugs or intoxicated by alcohol can there be clear consent given?

Yes

No

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* 4. Is it appropriate for you partner to coerce you into sexual activity?

Yes

No

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* 5. What type of relationship is it if a partner repeatedly and/or intentionally isolates you from friends and family?

Healthy relationship

Unhealthy relationship

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* 6. Communication is important in a healthy relationship.

True

False

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* 7. If you would like to be entered into the drawing for a gift card, please leave your contact information below!

Name

Email Address

Phone Number