1. Do you sometimes miss the old days, when you were happier in your relationship?
A. Not really, because it was all an act
B. No, because you are actually glad things are fading away
C. Yes, you are actually trying to work things out
D. No, because everything is still perfect
2. Can you say you still love your spouse/partner?
A. Yes, like crazy
B. Yes, sort of
C. Yes, sometimes
D. No, not at all
3. What do you think could be the reason your spouse/partner could be falling out of love with you?
A. Not enough time together
B. Not enough trust
C. Rivalry
D. Lack of money
4. When was the last time you fought with your spouse/partner?
A. Just last night
B. Just this week
C. Last year
D. You rarely fight, so you can't remember
5. What are the 2 things that you think bring you closer as a couple?
A. Sex and music
B. Money and travel
C. Luxury and fun
D. Nothing
6. What are the two things you think you disagree the most on?
A. Politics and religion
B. Food and spending
C. Places to go spend time to during weekends and interior decorating
D. Choices of wine and careers
7. What do you do with your spouse/partner to be just the two of you?
A. You book a hotel room for the weekend
B. You take a warm bath together with candles
C. You cook for your spouse/partner and drop the kids to your parents' house
D. You watch a movie together without the kids
8. When was the last time you had a calm and healthy exchange with your spouse/partner?
A. It's been almost two weeks
B. Last year
C. You can't remember
D. Just a few hours/minutes ago
9. If your marriage was in trouble today, who do you think amongst your spouse/partner siblings or acquaintances will give you clues about the source of the problem?
A. His/her sister
B. His/her father
C. His/her best friend
D. His/her coworker
10. What is a healthy relationship for you?
A. One where there is mutual respect
B. One where there is true love
C. One where there is individual freedom
D. One where there is a lot of compromises
11. Do you have mutual respect?
A. Yes, absolutely
B. Yes
C. A little bit, but we do disrespect each other sometimes
D. No
12. Is your partner supportive of the things you do?
A. Yes, always
B. Mostly
C. Sometimes
D. No
13. Does your partner encourage you to do things?
A. yes, always
B. Mostly
C. Sometimes
D. No
14. Does your partner listen to you without giving an opinion when that is what you need?
A. Yes, always
B. Mostly
C. Sometimes
D. No
15. Does your partner understand the concept of space and give it to you when needed?
A. Yes, always
B. Mostly
C. Sometimes
D. No
