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.

* 1. Current ages of couple:

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

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

* 4. Please provide gender.

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

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

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

* 8. Do you have children?

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

* 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.”

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

* 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.

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