My life is so filled with loving and supportive relationships that I have no desire for more friends and get all the support I typically need (aside from specific expertise) from them or family members.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I have all my physical and/or sexual intimacy needs met in a satisfying way that is in harmony with the rest of my life.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I have all my emotional intimacy needs met in a satisfying way that is in harmony with the rest of my life.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

There is no one with whom I have a sense of “unfinished business” nor  anyone who I know feels that way toward me.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I am appropriately assertive at all times—expressing my preferences, desires, and sense of boundaries, and being direct and appropriate in requests regarding these things.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

My relationships are a source of great joy, creative inspiration, and are mutually growth-inducing.

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I am able to be effectively selective in who I interact with or build relationship with. 

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I invest the appropriate amount of time in my relationships, relative to their value to me or commitments I have (e.g., children, aging parents).

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

I am balanced in giving and receiving in my relationships, having no significant problem on either side—I accept gifts, compliments, and help freely, as well as give them freely. 

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5

If I am not currently in the kind of intimate relationship I might desire with a long-term partner, I have a clear, detailed, written intention to attract that person into my life. 

○ NA      ○ 1     ○ 2      ○ 3       ○ 4       ○ 5