Couples Screening Form – Sarah Faircloth

  • Date Format: MM slash DD slash YYYY
  • Check the items that apply.
  • SATISFACTION AND COMMITMENT

  • Directions: In percentage terms, how strongly do you agree with the statements below.

    Use this scale to answer the questions below.

    0 = Not at all  |  25% = Slightly  |  50% = Moderately  |  75% = Very  |  100% = Extremely