1. Do you ever feel disrespect from your spouse?
A. Never
B. Rarely
C. Sometimes
D. Often
2. Do you ever feel physically threatened by your spouse?
A. Never
B. Rarely
C. Sometimes
D. Often
3. What is your relationship with alcohol and drugs?
A. We use them rarely, usually at social occasions
B. We drink or use substances occasionally
C. We use them quite often
D. We are a case of substance abuse
4. Are you certain your spouse is faithful?
A. Absolutely
B. Mostly certain
C. So-so
D. Not really
5. How well do you two communicate?
A. Very well
B. We do alright
C. Not very well
D. We barely speak to each other
6. Are you bored in your marriage?
A. Not at all
B. A little bit
C. Sometimes
D. We can’t stand each other
7. How often do you two go on dates?
A. Every weekend
B. Every two weeks
C. Rarely ever
D. Never
8. Has either of you cheated on the other?
A. Not at all
B. No
C. I suspect it
D. Yes
9. Do you and your partner live separate lives even under the same roof?
A. No
B. I don't think so
C. Yes
D. We have absolutely different lives
10. How often do you argue about money?
A. Never
B. Rarely
C. Sometimes
D. Often
11. How concerned are you about each other’s emotional needs?
A. Very much
B. Moderately
C. Not too much
D. Not at all
12. How do you cope with negative situations?
A. We talk through them without losing control
B. We fight but eventually get over
C. We ignore them
D. We fight a lot and our relationship degrades
13. What do you think about conflicts?
A. They are opportunities to evolve
B. They are annoying, but they are a part of life
C. They should be ignored
D. They are an impediment to happiness
14. How happy are you with physical intimacy in your relationship?
A. Very happy
B. Mostly happy
C. Moderately happy
D. Not really happy
15. Do you have the opportunity to spend quality time separately?
A. Yes, we manage to recharge batteries separately
B. Yes, but not as often as we'd like
C. Sometimes
D. Almost never
