Please rate your level of satisfaction for each of the following eleven (?) areas as you perceive them in your marriage on a scale of 0 to 5 where ‘0’ represents very low satisfaction and ‘5’ represents very high satisfaction. Please write the satisfaction rating in the blank to the left of each item.
Very Low Very High
_____ Overall Marital Satisfaction (How happy are you with your relationship right now?)
_____ Personality / Gender Differences
_____ Conflict Resolution
_____ Financial Management
_____ Leisure Activities (balancing time alone / together)
_____ Sexual Relationship
_____ Parenting (or decision for family)
_____ Family of Origin
_____ Role Relationship (decision making and household chores)
_____ Spiritual Intimacy
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