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* 1. I am

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* 2. I’ve been married for:

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* 3. What is my level of satisfaction in my marriage:

  Extremely Dissatisfied Dissatisfied Okay Satisfied Extremely Satisfied 
Fidelity/Faithfulness
Communication
Emotional Care
Emotional Security
Sexual Fulfillment
Financial Stability
Priorities
Child Raring
Christian Disciplines
Excitement/Fun
Intimacy
Freedom/Personal Space
Domestic Support

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* 4. Questions about adultery related to me

  Yes No
I have never cheated on my spouse (Yes, if this is true)
I have cheated in the past, and my spouse is unaware.
I’ve cheated in the past, and my spouse is aware
I am currently cheating on my spouse and they don’t suspect a thing
I am currently cheating on my spouse and they suspect something, but I have denied it
My spouse is aware that I am currently cheating
I have never cheated on my spouse
If I cheat(ed), I believe my spouse will forgive or have forgiven me

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* 5. Questions about adultery related to my spouse

  Yes No
I do not suspect that my spouse is currently cheating on me (Yes, if this is true)
I suspect that my spouse has cheated in the past
My spouse has cheated on me in the past
I suspect that my spouse has cheated on me but I have not addressed the issue
I suspect that my spouse has cheated on me but my spouse has denied it
I have forgiven my spouse for adultery
I am struggling to forgive my spouse for adultery

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* 6. This is my modest and humble opinion of myself regarding these important marriage areas:

  Definitely Need Improvement I Seeking Ways To Improve I Doing Okay  I Am Intentionally Mastering  I Have Mastered This
Fidelity/Faithfulness
Communication
Emotional Care
Emotional Security
Sexual Fulfillment
Financial Stability
Priorities
Child Raring
Christian Disciplines
Excitement/Fun
Intimacy
Freedom/Personal Space
Domestic Support

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* 7. If I had to do it all over again, I would marry my spouse again?

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* 8. What will make this conference successful for me is if we address this issue?

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