Finding Your ACE Score
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Date Of Birth
*
-
Month
-
Day
Year
Date
Email
example@example.com
While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often or very often... Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
*
Please Select
1 (yes)
0 (no)
2. Did a parent or other adult in the household often or very often... Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
*
Please Select
1 (yes)
0 (no)
3. Did an adult or person at least 5 years older than you ever... Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
*
Please Select
1 (yes)
0 (no)
4. Did you often or very often feel that... No one in your family loved you or thought you were important or special or Your family didn't look out for each other, feel close to each other, or support each other?
*
Please Select
1 (yes)
0 (no)
5. Did you often or very often feel that... You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
*
Please Select
1 (yes)
0 (no)
6. Were your parents ever separated or divorced?
*
Please Select
1 (yes)
0 (no)
7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
*
Please Select
1 (yes)
0 (no)
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
*
Please Select
1 (yes)
0 (no)
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
*
Please Select
1 (yes)
0 (no)
10. Did a household member go to prison?
*
Please Select
1 (yes)
0 (no)
Select your therapist
*
Please Select
Bailey Belknap
Ingrid Benyaminowich
Hannah Bickers
Megan Campagna
Aida Diallo
Lisa Evans
Scott Fralick
Jessica Glover
Lauren Greenberg
Melissa Grooms
Elizabeth Gunther
Pamela Hirt
Kelsey Hoisington
Jessica Jung
Nellimaria LaValle
Liz Lueptow
Caitlin Martin
Sara Matlack
Christal Mendenhall
Katherine Mullin
Sara Napp
Anne Price
Jordan Redman
Amber Riley
Patricia Ringold
Megan Sickles
Jenifer Sparks-Schaffner
Linda Strapp
Hillary Schmidt
MK Wright
This is your ACE Score:
Score
Submit
Should be Empty: