Physical Injury Checklist

Have you been physically injured by domestic violence?  The following are typical injuries that have resulted from physical violence in relationships where there is domestic violence. Check off those injuries that you have received during this relationship.

1 = Does not apply
2 = once but not serious
3 = once & needed medical care
4 = two to four times
5 = two to four times & needed medical care
6 = five or more times
7 = five or more times and needed medical care

Now go down the list again and put the initials M.D. in all the places where you did seek medical care.
 

Typical Domestic Violence Injuries