1. How do you generally feel these days?
A. I feel fine
B. I feel depressed
C. I feel I can make it work
2. Did you talk to your partner about how you feel?
A. Yes, they don’t pay heed
B. No, but I want to
C. Yes, but I am not sure if the message was well-received
3. Is there any domestic violence at home?
C. Nothing physical
4. Do you both argue a lot these days?
B. Yes, but we try not to
C. Not argue,, but there is discomfort
5. Do you think the fights are affecting your kids?
A. No, I don’t think so/ We don’t have kids
B. Yes, they seem withdrawn
C. Not yet, but soon, if this continues
6. Do you think you would be happier without them?
A. Yes, I think I would be
B. No, I don’t think so
C. I am not sure
7. Do you think you can communicate your feelings to them?
A. Yes, I believe so
B. Yes, but they won’t get it
C. No, I can’t
8. Do you think they will understand how you feel if you tell them?
C. Yes, I think so
9. Do you think they really love you despite the disagreements?
A. Yes, a lot
B. Yes, I do
C. Not really
10. Do you still feel the spark in your relationship?
A. Yes, I do
B. Yes, sometimes
C. Not anymore