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The Family Health History and Health Appraisal questionnaires were used to collect information on childhood maltreatment, household dysfunction, and other socio-behavioral factors examined in the ACE Study. The questionnaires are not copyrighted and there are no fees for their use. As a courtesy, a copy of articles on any research conducted using items from the questionnaires is requested.

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Family Health History Questionnaire

Male Version (PDF–190K)

Female Version (PDF–180K)

Health Appraisal Questionnaire

Male Version (PDF–85K)

Female Version (PDF–89K)

Page last reviewed: January 10, 2008
Page last modified: December 12, 2005
Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion

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Adverse Childhood
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4770 Buford Hwy, NE
MS K-67
Atlanta, GA 30341-3717

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