Questionaire

Project Lifeline

Questionaire

This questionaire requires no personal details of your identity and any additional information will be treated as confidential.

Have you or anyone you know been involved in domestic violence?	Yes
	No
Have you or anyone you know been subjected to violence from your child/children?	Yes
	No
Does your child self harm?	Yes
	I have suspicions
	Not that i am aware of
	No
Does your child drink alcohol or take any other drugs (non prescribed)?	Yes
	No
Do you feel that you could benefit from an organisation that is there to support you through these situations?	Yes
	No
Please feel free to add any additional information regarding your situation or comments or feed back on this site.

Thank you for taking a moment to participate in our questionaire we look forward to reading your views.