Part I: Basic Information about relationship

Introduction: This coming February New Mobility will publish its yearly Sex, Wheels and Relationships issue. The purpose of this survey is to find readers (couples) who are currently in relationships and who would be interested in being interviewed for our upcoming issue.

Current ages of couple:

Question Title

* 1. Current ages of couple:

Please specify your disability and age of onset.

Question Title

* 2. Please specify your disability and age of onset.

If your partner has a disability, please indicate type and age of onset.

Question Title

* 3. If your partner has a disability, please indicate type and age of onset.

Please provide gender.

Question Title

* 4. Please provide gender.

How would you characterize or define your relationship ? (e.g., married, civil union, long term partnership, committed, monogamous, open, polyamorous, etc.)

Question Title

* 5. How would you characterize or define your relationship ? (e.g., married, civil union, long term partnership, committed, monogamous, open, polyamorous, etc.)

How long have you been in current relationship?

Question Title

* 6. How long have you been in current relationship?

Please list briefly the most important positive characteristics of your relationship:

Question Title

* 7. Please list briefly the most important positive characteristics of your relationship:

Do you have children?

Question Title

* 8. Do you have children?

Would both of you be interested in sharing the story of your relationship with New Mobility readers?

Question Title

* 9. Would both of you be interested in sharing the story of your relationship with New Mobility readers?

We are particularly interested in hearing about how couples work through challenges, conflicts, and changes that arise. Would you be willing to share a story/experience about a bumpy experience in your relationship and how you and your partner worked through it? (e.g., fidelity, commitment, openness of relationships, experimentation, therapy, etc.) Note: it does not have to be injury/disability-related.”

Question Title

* 10. We are particularly interested in hearing about how couples work through challenges, conflicts, and changes that arise. Would you be willing to share a story/experience about a bumpy experience in your relationship and how you and your partner worked through it? (e.g., fidelity, commitment, openness of relationships, experimentation, therapy, etc.) Note: it does not have to be injury/disability-related.”

If a NM writer calls, would you feel comfortable in talking about your level of intimacy?

Question Title

* 11. If a NM writer calls, would you feel comfortable in talking about your level of intimacy?

If yes, would you be available to receive a call sometime between November 1-15? Please leave email and phone number (optional) and indicate which is best for making initial contact.

Question Title

* 12. If yes, would you be available to receive a call sometime between November 1-15? Please leave email and phone number (optional) and indicate which is best for making initial contact.

T