Quick Exit

Quick Exit

Survivor of Domestic Violence

COMPLETE QUESTIONNAIRE

Are you a Survivor of  Domestic Violence?

If your answer is YES, we would really appreciate your input,
experience and any help you can give to DARE. We would like to know,

If you feel comfortable, please fill out the questionnaire below which will be kept completely confidential. This will enable DARE to grow as a charity and provide you with a service if necessary. Please note:

N

Do not feel pressured to provide us with your name if you do not feel comfortable

N

We would really appreciate if you gave us your age and suburb so that we can find and develop a pattern

N

If you are happy for Karen Johns to contact you, please include your phone number or email address

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