Most persons have disagreements in their relationships. Please indicate below the approximate extent
of agreement or disagreement between you and your partner for each item on the following list.
Please answer using the following:
(1) Strongly Disagree (2) Somewhat Disagree (3) Somewhat Agree (4) Strongly Agree
How often would you say the following events occur between you and your mate?
These are some things about which couples sometimes agree and sometime disagree. Indicate if either
item below caused differences of opinions or were problems in your relationship during the past few
weeks. (Check yes or no)
This field is for validation purposes and should be left unchanged.