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* 1. What brought you to consider taking this survey?

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* 2. What is your age range?

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* 3. Are you still in an abusive relationship?

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* 4. Thinking about your relationship, did any of the following apply to you? (tick all that apply)

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* 5. Did any of the following apply in your relationship? (tick all that apply)

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* 6. In this relationship have you experienced any of the following (tick all that apply):

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* 7. When trying to leave the relationship, who did you tell?

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* 8. How long have you been trying to recover from your relationship?

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* 9. What help have you already had to help you recover and get over your relationship? (tick all that apply)

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* 10. What help, if any, do you need currently to recover?

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