Welcome to My Survey

Welcome and thanks for taking a few minutes to complete my BREAKING UP & BOUNCING BACK survey! The information you are about to provide contributes to my research on the process of breaking up. Your story (or parts of it) may also be included in my book, Breaking Up & Bouncing Back, about how to survive a soul-crushing breakup and develop healthy skills to a happy dating life. 

Some of the information I gather may be published, so by filling out this survey you are giving me permission to publish your response. It's your choice whether you want to provide your real name. If your response gets published, people will likely NOT be able to figure out exactly who you are--after all, there are 7+ billion people in this world! Providing the information in this survey does not mean I will definitely use it in my book.

Now, let's get down to business! Think of a past breakup that has impacted you emotionally, and keep this same breakup in mind when answering all of the questions. There are only 17 questions, so please respond to them all, otherwise I can't use your data. Thanks