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Marriage Satisfaction
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1
Name
First Name
Last Name
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2
Email
example@example.com
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3
What is your gender?
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Female
Male
Prefer not to say
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Please Select
Female
Male
Prefer not to say
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4
What is your age?
Please Select
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
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Please Select
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
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5
How long have you been married?
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< 1 year
1-4 years
5-9 years
10-14 years
15-19 years
20-29 years
30-39 years
> 39 years
Please Select
Please Select
< 1 year
1-4 years
5-9 years
10-14 years
15-19 years
20-29 years
30-39 years
> 39 years
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6
Is this your first marriage?
Please Select
Yes
No
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Please Select
Yes
No
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7
On scale 1(deeply dissatisfied) to 5(deeply satisfied), you would rate;
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The overall satisfaction with your marriage and your spouse.
The amount you and your spouse talk to each other.
The quality of your communication.
Your social life and friends and the amount of fun you have together.
The kind of parent your spouse is.
The degree of affection/intimacy that is given and received.
My spouse’s smoking, drinking or other habits.
My spouse’s overall appearance.
The overall satisfaction with your marriage and your spouse.
The amount you and your spouse talk to each other.
The quality of your communication.
Your social life and friends and the amount of fun you have together.
The kind of parent your spouse is.
The degree of affection/intimacy that is given and received.
My spouse’s smoking, drinking or other habits.
My spouse’s overall appearance.
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5
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5
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of 8
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8
Please choose true or false according to the situations given below.
True
False
I feel that I cannot rely on my spouse.
My spouse doesn’t understand me.
I feel that my spouse really cares for me.
I am able to trust what my spouse says and does.
Our conflicts usually don’t get fully resolved.
My spouse loses his/her temper at me often.
I don’t get enough space in our relationship.
I often hold back my true feelings from my spouse.
My spouse says things that put me down.
We don’t agree on how to handle our money.
I feel that I cannot rely on my spouse.
My spouse doesn’t understand me.
I feel that my spouse really cares for me.
I am able to trust what my spouse says and does.
Our conflicts usually don’t get fully resolved.
My spouse loses his/her temper at me often.
I don’t get enough space in our relationship.
I often hold back my true feelings from my spouse.
My spouse says things that put me down.
We don’t agree on how to handle our money.
True
False
True
False
True
False
True
False
True
False
True
False
True
False
True
False
True
False
True
False
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