1. Is your partner empathetic and understanding when you talk about yourself?
A. Yes
B. Not sure
C. No
2. Do you think your partner cares about you?
A. Yes
B. Not sure
C. No
3. Does your partner do anything frequently that upsets you?
A. Yes
B. Kind of
C. No
4. Do you still feel the affections you felt for your partner at the beginning of the relationship?
A. Yes
B. Kind of
C. Not really
5. Do you and your partner have fun when you're together?
A. Yes
B. Sometimes
C. No
6. Do you and your partner communicate your needs and feelings with each other?
A. Yes
B. Sometimes
C. No, never
7. Has your partner ever abused you?
A. Yes
B. Sometimes
C. No, never
8. Do you see a bright future for you and your partner?
A. Yes
B. Kind of / Not sure
C. No, not really
9. Are you currently unhappy in the relationship?
A. Yes
B. A little
C. No / Not sure
10. Have you been in a relationship with your partner for a long time?
A. Yes
B. Not actually
C. No
