1. Are you afraid that the separation will not end?
A. Yes, at times
B. Not in any way
C. I don’t know what the future holds
2. Do you find yourself regretting your relationship?
A. No, I don’t
B. Yes, I do
C. I’m not sure
3. Do you feel complete when he’s away?
B. Not at all
4. Do you see yourself losing him if he’s far away?
A. Sadly I do
B. I can’t lose him at all
C. I'm not sure
5. Do you think the communication will remain the same if he’s away?
A. I’m positive we will keep up communication
B. I’m not sure if he will be willing to communicate
C. No, I doubt it
6. Is separation anxiety killing your relationship?
A. Yes, it is destroying my relationship
B. No, it is not
C. I’m not even sure
7. Do you feel he’s worth the wait if he’s far away?
8. Can you cope with a long distance relationship while your boyfriend is out of town?
A. I will try but I’m not sure
B. Yes, I can cope
C. No, I cannot
9. Do you experience physical signs of distress such as headaches or physical pains when you’re not with your boyfriend?
A. Funnily enough, yes
B. No, never happened to me
C. I think I do, but maybe it’s my imagination
10. Do you have trust issues?
A. No, I trust my boyfriend
B. Yes, I don’t think my boyfriend is faithful
C. Sometimes, I consider the possibility of my boyfriend being unfaithful