COUPLES THERAPY QUESTIONNAIRE
APPENDEX -I C O UP LES THE RAP Y Q U EST I O NNA I R E Balabharathi Turapati RCWC P l e a se co m pl ete t h is qu e sti o n na ire w it ho ut in p ut f r o m y o ur sp o use/ pa r t ner. E ac h pa r t ner sh o uld co m pl e te h i s / h er own qu e st i o n na ir e . N a m e : P a r tn e r ’ s N a m e : S t a tus ( c ir c le o n e ): E n g a g e d M a rr i e d S e p a r a t e d D i v or ce d L i v e T o g e th e r O th e r H ow long h a v e y ou b ee n in this r e l a t ion s hi p ? If y ou a re m a rr i e d, how l o ng did y ou d a te b e f ore ma rr ia ge ? D id y ou li v e to g e th e r b e fo re m a rr i a ge ? I f y e s , how lon g ? L i s t pr e v ious m a rr ia g