Introduction

The following questionnaire is normally completed in conjunction with a consultation with Sharon or Dawson of FamilyWorks.

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Your Name

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Mobile

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Email

The following statements concern how you generally feel in close relationships (e.g., with romantic partners, close friends, or family members).
Respond to each statement by indicating how much you agree or disagree with it.

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Please select one of the two following options...

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1. It helps to turn to my romantic partner in times of need.

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2. I need a lot of reassurance that I am loved by my partner.

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3. I want to get close to my partner, but I keep pulling back.

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4. I find that my partner doesn't want to get as close as I would like.

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5. I turn to my partner for many things, including comfort and reassurance.

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6. My desire to be very close sometimes scares people away.

 

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