Name ___________________________________
Male Female
State the approximate
extent of agreement or disagreement between you and your mate on the
following items. Please check each column.
Always
Agree |
Almost
always Agree |
Occa-
sionally Disagree |
Fre-
quently Disagree |
Almost
always Disagree |
Always
Disagree |
2. Handling family finances | 5 | 4 | 3 | 2 | 1 | 0 |
3. Matters of recreation | 5 | -- | -- | -- | -- | 0 |
4. Demonstration of affection | 8 | 6 | 4 | 2 | 1 | 0 |
5. Friends | 5 | 4 | 3 | 2 | 1 | 0 |
6. Sex relations | 15 | 12 | 9 | 4 | 1 | 0 |
7. Conventionality (right,
good, or proper
conduct) |
5 | -- | -- | --- | -- | 0 |
8. Philosophy of life | 5 | -- | -- | -- | -- | 0 |
9. Ways of dealing with in-laws | 5 | --- | -- | -- | -- | 0 |
11 .Do you and
your mate engage in outside interests together:
All of them 10
Some of them 8
Very few of them 3
None of them 0
12. In leisure time do you generally prefer: 1 To be "on the go," To stay at home?
13. Do you ever
wish you had not married?
Frequently 0
Occasionally 3
Rarely 8
Never 15
14. If you had
your life to live over, do you think you would:
Marry the same person 15
Marry a different person
0
Not marry at all 1
15. Do you confide
in your mate: Almost never 0
Rarely 2 In most things
10 In everything
10
To Self-report |