Your name
Your email address
Your faith
Christian Other
Your gender
Male Female
Your country
Your age (years completed)
Your age at the time of marriage
Present marital status
Married Separated Divorced Widowed
If remarried, number of marriages
If remarried, number of years between marriages
Number of children
Income level of the family
Poor Lower middle Upper middle Rich
Type of husband’s work
Own business Employed Unemployed
Husband’s qualifications
School Graduate Masters Doctorate
Husband’s income
Nil Low Medium High
Husband’s working hours
Normal Long Extra long
Husband’s work pattern
Regular Shifts
Type of wife’s work
Housewife Working from home Working outside
Wife’s qualifications
School Graduate Masters Doctorate
Wife’s income
Nil Low Medium High
Wife’s working hours
Normal Long Extra long
Wife’s work pattern
Regular Shifts
Are you staying together with your spouse?
Yes No
If ‘No’, is it because your spouse is working in another place?
Yes No
Number of hours per day when husband and wife are together at home
Number of waking hours per day husband and wife spend together
Do you share the same religious faith as your spouse?
Yes No
Do you eat together?
Rarely Now and then Often
Do you watch TV together?
Rarely Now and then Often
Do you work together in the kitchen?
Rarely Now and then Often
Do you go out together for walks?
Rarely Now and then Often
Do you go out together for social/cultural events?
Rarely Now and then Often
How much do you talk together per day?
Up to 15 min 30 min 1 hour 2 hours More than 2 hours
Do you get upset with each other?
Very little Now and then Often Very often
Do you quarrel with each other?
Very little Now and then Often Very often
Is there physical violence between both of you?
Never Sometimes Often Very often
When you get upset with your spouse do you wish to do something violent?
Never Sometimes Often Very often
What happens after a quarrel?
Make up quickly Stop talking for a long time Talk to others about it Ignore it and carry on Discuss and settle it
Do you discuss problem issues together?
Rarely Sometimes Often Very often
Are you afraid to address problem issues with spouse?
Yes No Sometimes Very often
Do you think your spouse is the major cause of your problems?
Yes No
If you made a mistake, do you apologise to your spouse?
Yes No Sometimes Very often
Do you share with your spouse about things that bother you?
Rarely Now and then Often
Do you think your spouse has time to listen to you?
Rarely Now and then Often
Do you think you have time to listen to your spouse when he/she comes to talk about his/her problems?
Rarely Now and then Often
Do you tell your spouse about the things you appreciate about him/her?
Rarely Now and then Often
How long ago did you express your appreciation about your spouse in front of others?
Days Weeks Long ago
How long ago did you express your unhappiness about your spouse in front of others?
Days Weeks Long ago
Do you have fun or share jokes with your spouse?
Rarely Now and then Often
Do you make fun of your spouse in private?
Rarely Now and then Often
Do you make fun of your spouse in front of others?
Rarely Now and then Often
Do you talk together before making major decisions?
Rarely Now and then Often
Do you feel your spouse does not really understand you?
Rarely Sometimes Often
Do you think you understand your spouse well?
To a large extent Moderately To a small extent
Can you anticipate what your spouse will say or do?
Rarely Sometimes Often
Do you try to correct/train/teach your spouse?
Rarely Sometimes Often
Does your spouse appreciate the way you try to correct/train/teach him/her?
Rarely Sometimes Often
Do/Did you and your spouse agree on the number of children you would like to have?
Yes No
Do/Did you or your spouse think that children are burdens on your life?
Yes No
Do/Did you or your spouse think that children are a drain on your income?
Yes No
Do/Did you and your spouse agree on the way to discipline/train your children?
Yes No
Do/Did you share the responsibility of bringing up your children?
Yes No
Does/Did your spouse share the responsibility of bringing up your children?
Yes No
Do/Did you both depend to a major extent on others to bring up your children?
Yes No
Do you think your children are generally doing well?
Yes No
Do you have a well-adjusted sex life?
Yes No
How often did you have sexual relations immediately after you got married?
Rarely Often Very often
How often do you have sexual relations now?
Rarely Often Very often
Do you think your spouse is asking for too much sex?
Yes No
Do you think your spouse is not cooperating with you enough in sexual relationships?
Yes No
Do you think your spouse is asking you to do things you don't like?
Yes No
If you are a wife, are you afraid of childbirth?
Yes No
Are you happy that your spouse is also earning?
Yes No
How do you manage your incomes?
Separately As one income Separately, with mutual understanding
Do you and your spouse know how much you are both earning?
Yes No
Do you and your spouse know how much you are spending?
Yes No
Do you discuss expenditure/savings/strategies?
Yes No
Are you able to manage within your income?
Yes No
Do you wish you could have more happiness even at the cost of less income?
Yes No
What would you rate as the best point in your wife?
Attractive looking Good cook Takes care of home Takes care of children Sexual relationship Good friend to talk to Careful with money Your best fan A good balance for you A good partner in life Nothing special
What would you rate as the second best point in your wife?
Attractive looking Good cook Takes care of home Takes care of children Sexual relationship Good friend to talk to Careful with money Your best fan A good balance for you A good partner in life Nothing special
What would you rate as the third best point in your wife?
Attractive looking Good cook Takes care of home Takes care of children Sexual relationship Good friend to talk to Careful with money Your best fan A good balance for you A good partner in life Nothing special
What would you rate as the worst point in your wife?
Does not cooperate in sex Spends too much Wants to talk all the time Complaining Quarrelling Nagging Domineering Negligent in appearance Disinterested cook Not taking care of the home Too tired all the time Nothing special
What would you rate as the second worst point in your wife?
Does not cooperate in sex Spends too much Wants to talk all the time Complaining Quarrelling Nagging Domineering Negligent in appearance Disinterested cook Not taking care of the home Too tired all the time Nothing special
What would you rate as the third worst point in your wife?
Does not cooperate in sex Spends too much Wants to talk all the time Complaining Quarrelling Nagging Domineering Negligent in appearance Disinterested cook Not taking care of the home Too tired all the time Nothing special
What would you rate as the best point in your husband?
Understanding Affectionate Considerate Listens to me Earns well Helps at home Helps with the children A good friend Handsome Respected in society Nothing special
What would you rate as the second best point in your husband?
Understanding Affectionate Considerate Listens to me Earns well Helps at home Helps with the children A good friend Handsome Respected in society Nothing special
What would you rate as the third best point in your husband?
Understanding Affectionate Considerate Listens to me Earns well Helps at home Helps with the children A good friend Handsome Respected in society Nothing special
What would you rate as the worst point in your husband?
Too much sex No time for conversation Not interested in the home No time for children No respect for me Does not understand my problems I don’t know if he loves me Too lazy to work Abusive Womanising Nothing special
What would you rate as the second worst point in your husband?
Too much sex No time for conversation Not interested in the home No time for children No respect for me Does not understand my problems I don’t know if he loves me Too lazy to work Abusive Womanising Nothing special
What would you rate as the third worst point in your husband?
Too much sex No time for conversation Not interested in the home No time for children No respect for me Does not understand my problems I don’t know if he loves me Too lazy to work Abusive Womanising Nothing special
Overall: how would you rate your marriage? (1-Hopeless 10-Excellent)
What are you willing to do for enhancing your relationship"
For husbands only
Will you show your affection to your wife often through kind words, words of appreciation, hugs, kisses, gifts, treating her in a special way on her birthday and your anniversary day?
Rarely Often Very often
Will you give her a listening ear when your wife tries to share her feelings, thoughts, challenges, frustrations, etc.?
Rarely Often Very often
Will you be open with your wife about your activities, friendships, transactions, plans, etc.?
Rarely Often Very often
Will you share with your wife about your financial status and make her feel comfortable about the provisions you have made for her?
Rarely Often Very often
Will you take interest and share responsibility with your wife for raising up your children?
Rarely Often Very often
Will you let your wife know and feel that she is the most important person in your life?
Rarely Often Very often
How often will you pray to God to help you to love and stay faithful to your wife?
Rarely Often Very often
For wives only
Will you recognise your husband's strong sexual need and cooperate with him when he comes to you?
Rarely Often Very often
Will you be a supporting companion to your husband when he tries to enjoy his hobby or recreation?
Rarely Often Very often
Will you encourage your husband by showing him appreciation and admiration?
Rarely Often Very often
Will you try to make yourself look attractive to your husband in your appearance?
Rarely Often Very often
Will you take responsibility for managing the household so that your husband will love to come home?
Rarely Often Very often
Will you let your husband know and feel that he is the most important person in your life?
Rarely Often Very often
How often will you pray to God to help you to love and stay faithful to your husband?
Rarely Often Very often
Any other comments you would like to offer
If you would like to receive some marriage counselling, for men and women, go to my Marriage Column , where you can also read some articles that can enhance your marriaage.