If this is not your first marriage, indicate dates for each prior marriage (e.g., Marriage #1: married in 1995, separated in 2000, legally divorced in 2002; same for Marriage #2, etc.). Unmarried couples: skip to the next question.

Were you ever engaged to someone else and did not marry? When? Why did it end? 

Prior to the current relationship, did you cohabit with a romantic partner? When? Why did it end? 

In general, how often do you think that things between you and your Partner are going well?

Do you and your Partner still talk as friends, confide in one another, ask each other for advice? 

How often do the following topics come up in the relationship: divorce, separation, breaking up?

When did the following topics first come up in the relationship: divorce, separation, breaking up?

In couples counseling, it is not uncommon for Partners to lean in different directions about whether to stay together or end the relationship. Enter the number that best describes your own “leaning” at this moment (5 = I'm not sure).

What is your best guess for how your Partner is leaning? (5 = I'm not sure).