Survey

Thank you for requesting your personal consultation.

Complete the assessment curvey so that I have a better understanding of
your needs and relationship.

When you complete the survey you will receive an assessment of the strength
of your relationship.

Use this to determine the next step in rekindling your relationship.

These questions have been adapted from the BARE assessment created by Sandberg, Busby, Johnson, Yoshida.

What worries or concerns do you have most about your marriage?

I can get my partners attention easily.
	Always
	Most of the time
	Enough that I don't feel abandoned.
	Rarely, unless I really make a production.
	Never

My partner is easily to connect with emotionally.
	Always
	Mostof the time
	Enough that I don't feel abandoned.
	Rarely, unless I really make a production.
	Never

My partner shows me that I come first with him or her.
	Always
	Most of the time
	Enough that I don't feel abandoned
	Rarely, unless I really make
	Never

I am not feeling lonely or shut out in this relationship.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

I can share my deepest feelings with my partner. He/she will listen.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

I find I can lean on my partner when I am anxious or unsure.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

If I need connection and comfort he/she will be there for me.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

My partner responds to signals that I need him/her to come close.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

Even when we fight or disagree, I know I am important to my partner and we will find a way to come together.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I relly make a production
	Never

If I need reassurance to know how important I am to my partner I can get it.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

I feel very comfortable being close to and trusting my partner.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

I can confide in my partner about almost anything.
	Always
	Most of the time
	Enough I don't feel abandoned
	Rarely, unless I make a production
	Never

I feel confident even when we are apart that we are connected to each other.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I make a production
	Never

I know that my partners cares about my joys, hurts, and fears.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I really make a production
	Never

I feel safe enough to take emotional risks with my partner.
	Always
	Most of the time
	Enough that I do not feel abandoned
	Rarely, unless I make a production
	Never