1. How long has your marriage been troubled for?
A. For less than a month
B. For half a year
C. For about a year
D. For more than a year
2. When was the last time you have been intimate with your spouse?
A. Within the last week
B. Weeks ago
C. Months ago
D. Can't even remember
3. Do you two have children together?
A. Yes, two or more
B. Yes, one
C. No, but we were planning
D. No, and I couldn't imagine us having children
4. Do you still live together?
A. Yes, we sleep in the same bed
B. Yes, in different rooms
C. Yes, but we have plans for separation
5. Have you and your spouse ever discussed divorce or separation?
B. A few times
C. Multiple times
D. We already are separated
6. How often do you have major disagreements?
A. Almost never
B. A few times a month
C. A few times a week
D. Every day
7. Have you considered marriage counseling?
A. Yes, and it sounds like a good idea
B. We have mentioned it a couple of times
C. My spouse refuses to attend counseling
D. We have not even discussed it
8. If you have tried counseling, how effective was it?
A. Very effective
B. Somewhat helpful
C. Made things worse
D. Not applicable because we have not been to counseling
9. How optimistic do you feel about the chances of saving your marriage?
A. Very optimistic
B. Quite optimistic
C. Not very optimistic
D. Not at all optimistic
10. Has your spouse cheated on you?
B. I don't think so