1. Have either of you been thinking about ending the relationship?
   Yes No
2. Are things worse now than they were before?
   Yes No
3. Do you have arguments where you hurt each other's feelings?
   Yes No
4. Do you feel frustrated that things aren't changing?
   Yes No
5. Do you have the same disagreements over and over again?
   Yes No
6. Have you tried to improve things but had no success?
   Yes No
7. Do you avoid each other so you won't have conflict?
   Yes No
8. Is there less affection, intimacy or lovemaking?
   Yes No
9. Do you feel more distant now?
   Yes No

If you checked even one or two as "Yes", your relationship may be in trouble.
If you checked three or more as "Yes", your relationship definitely is in trouble. And it's time to seek help.

If you would like discuss your test results with Dr. Woodsfellow, please fill out the following:

Describe your situation (in 100 words or less)

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