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ACEs - Adverse Childhood Experiences

Have you ever taken the ACEs questionnaire?
Yes
No
I've Never Heard of it
If you answered yes to the previous question, was this test given to you by a healthcare/medical provider or in a healthcare setting (i.e., primary care physician, therapist, school nurse, rehab facility)?
Yes
No
N/a
If you answered 'no' or 'I've never heard of it' to the first question, do you feel that you experienced any sort of trauma/abuse/adverse childhood experiences before the age of 18?
Yes
No
N/a
Do you have a doctor or PCP that you see regularly for well-visits/checkups?
Yes
No
I only go to the doctor when I am sick
Do you feel that your adverse childhood experiences have had an impact on your current physical health?
Yes
No
I'm not sure.
N/A
Do you feel that your adverse childhood experiences have had an impact on your mental health??
Yes
No
I'm not sure.
N/A
Have you ever attended therapy for yourself individually? (not group, family or marital counseling)
Yes
No
If you answered yes in the previous question - do you still currently attend?
Yes
No
Have you experienced any physical, verbal or sexual abuse as an adult?
Yes
No
Please select your age range
18-24
25-34
35-44
45-54
55-64
65 and over
Current relationship status
Single
Married
Divorced
Widowed
It's Complicated
Do you have children?
Yes
No
Do you have siblings?
Yes - I'm the oldest
Yes - I'm a middle child
Yes - I'm the youngest
No - I'm an only child
Highest level of education completed
Didn't finish high school
High school
Some college
College degree (associate's and higher)
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