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* 1. What is your age?

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* 2. Are you male or female?

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* 3. What is your marital status?

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* 4. If you are married, how would you describe your satisfaction in your marriage?

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* 5. If you are married, how long have you been married?

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* 6. Have you been married more than once?

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* 7. Do you have children?

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* 8. If YES, how many?

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* 9. What issues do you struggle with the most in your marriage?

  No Struggle Minor Struggle Struggle Major Struggle
Communication
Finances
Extended Family
Parenting
Sexual Intimacy
Dating
Spiritual Life

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