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

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Check the dot on the scale line which best describes the degree of happiness, everything considered, of your present relationship. The middle point "happy" represents the degree of happiness which most people get from relationship.

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State the approximate extent of agreement or disagreement between you and your partner on the following items.

  Almost always agree Always agree Occasionally disagree Frequently disagree Almost always disagree Always disagree
Handling Family Finances
Matters of Recreation
Demonstrations of Affection
Friends
Sex
Conventionality (right, good, or proper conduct)
Philosophy of Life
Ways of dealing with in-laws

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When disagreements arise, they usually result in:

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Do you and your partner engage in outside interests together?

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In leisure time do you generally prefer:

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Does your partner generally prefer:

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Do you ever wish you had not married (or partnered in this way)?

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If you had your life to live over again, do you think you would:

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Do you ever confide in your partner:

Based on Lock-Wallace Marital Adjustment Test
 

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