Questionnaires

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.

One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader (a free application) to view and print these documents.

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