Do you wake up and go to sleep together?

Do you have any daily or weekly rituals together, such as going to the store together? Or date night?

Do you tend to solve problems together or separately?

How many times do you engage intimately per week/ per month?

Are you sexually satisfied? If not, what is one thing that your partner could do to help move this forward with you?

Do you feel more or less connected with your partner during sexual engagement?

Childhood: 1. Who was your go to person as a child? Are they still in your life? If not at what age did they exit?

Where you left alone to play by yourself as a child?

Did you take care of your parents more than they took care of you?

Where you expected to stay young, cute and dependent or grow up and be self-sufficient?

Where you misunderstood as a child? In what ways?

Evaluation: 1. “I’m fine by myself, but I prefer the give-and-take of an intimate relationship.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I value my close relationships and will do what it takes to keep them in good condition.”Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I love people, and people tend to love me.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“Lots of physical contact and affection is fine with me.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I’m equally relaxed when I’m with my partner and when I’m alone.”  Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“Interruptions by my loved ones do not bother me.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I know how to take care of myself better than anyone else could.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me

“I’m a do-it-myself kind of person.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I thrive when I can spend time in my own private sanctuary.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“If you upset me, I have to be by myself to calm down.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me! 

“I often feel my partner wants or needs something from me that I can’t give.”Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!  

“I’m most relaxed when nobody else is around.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

 “I’m low maintenance, and I prefer a partner who also is low maintenance.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I take better care of others than I do of myself.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I often feel as though I’m giving and giving, and not getting anything back.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“I thrive on talking to and interacting with others.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“If you upset me, I have to talk in order to calm down.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

“My partner tends to be rather selfish and self-centered.” Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That’s me!

 “I’m most relaxed when I’m around my friends.” Love relationships are ultimately disappointing and exhausting. You can never really depend on anyone.”  Please rate the following sentences 0-5.  0= that’s not me at all.  5= oh yeah! That's me!