| What is your gender? |
|
| What is your age? |
|
| Where do you currently
live? |
|
| Please estimate
your annual household income ( US dollars). |
|
| Which of the following
best describes your occupation? |
|
| What is your
marital status? |
|
| How would you describe
your current primary relationship? |
|
| How would you
characterize your current primary relationship? |
|
| How would you describe
your relationship with respect to making major decisions? |
|
| What action on
your part do you believe would most help to improve your current relationship?
(choose one) |
|
| What action
on your signficant other's part do you believe would most help to improve
your current relationship? (choose one) |
|