Support Question Title * 1. Do you feel supported in your relationship? Yes No Sometimes Question Title * 2. Are children involved in your relationship? Yes No Question Title * 3. Does one partner in the relationship have more responsibilities than the other inside/outside of the home? Indicate how so below. Question Title * 4. Do you and your partner have set responsibilities in the home? Yes No Question Title * 5. Does one partner have to ask the other for things to get completed? Ex. Changing laundry from the washer to the dryer, and automatically starting a new load without being asked. Yes No Sometimes Question Title * 6. If there are child/ren in the home, are both partners equal in caring for the child/ren? List below what role you play:Ex. of equal: One partner makes lunches while the other helps with homework. Ex. of significant difference: One partner takes care of most if not all child/ren related tasks, while the other does nothing or very little. Yes, equal No, significant difference Sometimes N/A Question Title * 7. In a child free home: Are the responsibilities equal between partners? If yes, indicate below how so. If no, indicate below, and the differences. Question Title * 8. Do you work full time/ part-time (inside/outside of the home)? Are you a stay at home parent, or student. Indicate below if more than one answer applies to you. Full time Part time Stay at home parent Not currently working Full time student Part time student Other- provide answer below Question Title * 9. Would you consider going to therapy, for the betterment of your relationship if your partner asked you to? Yes No Other-indicate below Question Title * 10. Which selection describes you? Male Female Non-binary Done