1. Has your girlfriend become more distant or is showing you significantly less affection than she used to?
A. No, that has not changed
C. It seems to eb and flow, it’s not really consistent
D. It seems to eb and flow, it’s not really consistent
2. Do you feel like your girlfriend has shut off her emotions and attraction towards you?
B. Yes, definitely
3. Do you feel like your girlfriend is trying to push you away or create tension on purpose?
D. I don’t know
4. Has she recently changed things about her appearance or started putting more effort into how she looks before she leaves the house?
C. Sometimes, but not always
D. I don’t think so, but I am not sure
5. Has she stopped inviting you places with her as often as she used to or spending significantly more time with friends than normal?
A. No, it’s about the same
B. Yes, very much so
C. I wouldn’t say it is a significant change, but there is definitely a shift
D. Not really, she doesn’t really go out with friends much
6. Does she encourage you to go out with your friends, have your friends over to do something together or suggest other things for you to do without her that are not typical for her?
A. No, not that I noticed
C. At times I do feel that way
D. I don’t think so
7. Is she more vague than normal about how her night went, who she was with or what she did all night?
B. Yes, always
C. Sometimes she definitely is, but not every time
D. She doesn’t go out much, but in depth conversations have just been more of a struggle in general lately
8. Does she seem much more preoccupied with her phone or spending significantly more time on social media than in the past?
A. No, it’s the same
B. Yes, for sure
9. Does she seem more private with her cell phone, computer, etc. than she used to be (i.e. leaving the room to take a phone call, changing passwords to prevent you from looking at their stuff, being careful to not let you see her screen, etc.)?
10. Does she seem to show less interest in sex or other forms of intimacy with you?
A. No, It’s about the same
B. She is much less interested than she used to be
C. Sometimes I feel that way, but it could just be the natural progression of a relationship
D. Nothing significant, only slight changes at times