1. Do you argue too much?
A. Yes
B. Sometimes
C. Maybe
D. No
2. Do you disagree all the time?
A. Alot
B. Our disagreements are increasing
C. Sometimes
D. It's possible
3. Do you enjoy each other sexually?
A. It has been quite a while since you last had sex
B. I do not feel sexually attracted to him
C. Rarely
D. Frequently
4. Does your husband leave you by yourself in the house?
A. Yes
B. No
C. Sometimes
D. It's happens but it's rare
5. Does your husband belittle you in public?
A. Yes
B. He might have
C. Sometimes
D. Never
6. Do you think your husband is cheating on you?
A. Yes
B. Maybe
C. You have your doubts but you can’t prove it
D. No
7. Do you feel like you are in love with someone else?
A. Yes
B. Maybe
C. You have your doubts but you can’t prove it
D. No
8. Do you feel like you still connect emotionally with your husband?
A. No
B. Yes, but it's rare
C. Sometimes
D. Yes, very often
9. Do you feel like your husband is very toxic to you?
A. Yes
B. A little bit
C. It's possible
D. No
10. Do you sometimes feel like an urge to leave and never come back?
A. Yes
B. I am thinking about it
C. Sometimes
D. No