1. Has your wife ever physically or emotionally abused you?
A. Yes
B. Sometimes
C. No
2. Has your wife ever sexually abused you?
A. Yes
B. Sometimes
C. No
3. Do you love your wife?
A. Yes
B. Sometimes
C. No
4. Has your wife ever cheated on you?
A. Yes
B. Sometimes
C. No
5. Have you been having fights that are impacting your mental health?
A. Yes
B. Sometimes
C. No
6. Are you ruining each other's mental health and/or well-being?
A. Yes
B. Sometimes
C. No
7. Have you tried having an honest conversation about your relationship? Did it help?
A. Yes, we had an honest conversation, but it didn’t help
B. Yes, we had an honest conversation, and it helped a little
C. No, we haven’t had an honest conversation
8. Do you have any dependents that might be adversely impacted by your divorce?
A. Yes
B. Kind of, but they won’t be impacted a lot
C. No
9. Have you been thinking about getting a divorce lately?
A. Yes
B. Sometimes
C. No
10. Have you and your wife received marital counselling?
A. Yes
B. Sometimes
C. No
