Spousal Assurance and Security Survey

Spousal Satisfaction: Assurance & Security

The purpose of this questionnaire is to provide your partner/spouse with some feedback on your perspective on the level of assurance and security in the relationship. This questionnaire intends to identify areas for improvement. Please read each statement below and score 0 (needs improvement) – 10 (excellent). Then calculate each number at the end. Best results are experienced when you are authentic in your response. This questionnaire should not be employed to degrade or humiliate but establish a baseline so you can build a road map toward discovering your unique, intimate expressions.

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* 1. What is your gender?

Female

Male

Non-Binary

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* 2. Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 3. What is your age?

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* 4. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

Cohabiting with a significant other or in a domestic partnership

Single, never married

Prefer not to answer

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* 5. I feel assured that my spouse/partner loves and appreciates my company. I feel emotionally connected with my spouse/partner.

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* 6. I feel assured that my spouse/partner loves my body, shape, size, taste, and smell. Their enthusiasm about my presence makes me feel proud to have them in my life.

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* 7. My spouse/partner is dedicated to pleasing me sexually and fulfills my sexual needs.

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* 8. My spouse/partner loves me and is sensitive to the needs of my vagina, vulva, and uterus (Yoni) or penis, scrotum and perineum (lingam).

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* 9. When spending quality time, I can sense that my spouse/partner wants to be with me.

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* 10. Whenever I express a concern, my spouse/partner responds to resolving the issue and puts my mind at ease, knowing I will be taken care of. I don't have to remind them more than twice.

Spousal Assurance and Security Survey

Spousal Satisfaction: Assurance & Security

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* 1. What is your gender?

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* 2. Which race/ethnicity best describes you? (Please choose only one.)

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* 3. What is your age?

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* 4. Which of the following best describes your current relationship status?

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* 5. I feel assured that my spouse/partner loves and appreciates my company. I feel emotionally connected with my spouse/partner.

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* 6. I feel assured that my spouse/partner loves my body, shape, size, taste, and smell. Their enthusiasm about my presence makes me feel proud to have them in my life.

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* 7. My spouse/partner is dedicated to pleasing me sexually and fulfills my sexual needs.

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* 8. My spouse/partner loves me and is sensitive to the needs of my vagina, vulva, and uterus (Yoni) or penis, scrotum and perineum (lingam).

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* 9. When spending quality time, I can sense that my spouse/partner wants to be with me.

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* 10. Whenever I express a concern, my spouse/partner responds to resolving the issue and puts my mind at ease, knowing I will be taken care of. I don't have to remind them more than twice.

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* 11. My spouse/partner showers me with appreciation, affirmation and often compliments me. My spouse makes me feels good about myself.

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* 12. The level of trust and security I feel when I'm with my spouse/partner. They take care of me when we are together.

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* 13. My spouse/partner respects me and values my opinion. I feel that I can provide my honest thought without them becoming defensive.

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* 14. My overall satisfaction with my emotional and spiritual connection with my spouse/partner.