Type your name (optional):

Type your email address (optional):

Select your gender:

Your Gender? Male Female

Select your age:

Your Age? less than 18 years 18 years old 19 years old 20 years old 21 years old 22 years old 23 years old 24 years old 25 years old 26 years old 27 years old 28 years old 29 years old 30 years old 31 years old 32 years old 33 years old 34 years old 35 years old 36 years old 37 years old 38 years old 39 years old 40 years old 41 years old 42 years old 43 years old 44 years old 45 years old 46 years old 47 years old 48 years old 49 years old 50 years old 51 years old 52 years old 53 years old 54 years old 55 years old 56 years old 57 years old 58 years old 59 years old 60 years old 61 years old 62 years old 63 years old 64 years old 65 years old over 65 years old

Select your spouse's gender:

Spouse's Gender? Male Female

Select your spouse's age:

Spouse's Age? less than 18 years 18 years old 19 years old 20 years old 21 years old 22 years old 23 years old 24 years old 25 years old 26 years old 27 years old 28 years old 29 years old 30 years old 31 years old 32 years old 33 years old 34 years old 35 years old 36 years old 37 years old 38 years old 39 years old 40 years old 41 years old 42 years old 43 years old 44 years old 45 years old 46 years old 47 years old 48 years old 49 years old 50 years old 51 years old 52 years old 53 years old 54 years old 55 years old 56 years old 57 years old 58 years old 59 years old 60 years old 61 years old 62 years old 63 years old 64 years old 65 years old over 65 years old

Select the total number of years you have been in your present relationship:

Years In Present Relationship? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 over 30

Select the total number of years you have been living together:

Years Living Together? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 over 30

Select the total number of years you have been married: 

Years Married? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 over 30

Total number of kids in your stepfamily: 

Total Number of Kids in Stepfamily? 0 1 2 3 4 5 6 7 8 9 10 more than 10

.

Total number of "full-time" kids living in your home now:

Full-Time Kids Living In Home Now? 0 1 2 3 4 5 6 7 8 9 10 more than 10

.

Total number of "part-time" kids living in your home now:

Part-Time Kids Living In Home Now? 0 1 2 3 4 5 6 7 8 9 10 more than 10

.

Total number of "Her Kids" living in your home now: 

Her Kids Living In Home Now? 0 1 2 3 4 5 6 7 8 9 10 more than 10

.

Total number of "His Kids" living in your home now: 

His Kids Living In Home Now? 0 1 2 3 4 5 6 7 8 9 10 more than 10

.

Total number of "Our Kids" living in your home now: 

Our Kids Living In Home Now? 0 1 2 3 4 5 6 7 8 9 10 more than 10

~~~ 

Select the current ages of all "full-time" and "part-time" kids living in the home. (Check all that apply. Don't worry if two or more kids are the same age. In this survey we are primarily interested in the age levels present in the home.):

 ~~~

How satisfied are you with your current circumstances as a stepfamily?

How Satisfied With Circumstances? Very Satisfied More Satisfied than Disatisfied More Dissatified than Satisfied Very Dissatisfied

.

How satisfied are you with your current circumstances as a couple?

How Satisfied With Relationship? Very Satisfied More Satisfied than Disatisfied More Dissatified than Satisfied Very Dissatisfied

.

Which of the following do you feel is the "number one" problem for you as a couple, or for the family right now?

Number One Problem? Dealing With The Ex(s) Money and Finances Parenting and Discipline Communication Trust Intimacy Recreation and Fun Visitation Holidays Other

.

Which of the following do you feel is the "number two" problem for you as a couple, or for the family right now?

Number Two Problem? Dealing With The Ex(s) Money and Finances Parenting and Discipline Communication Trust Intimacy Recreation and Fun Visitation Holidays Other

.

Which of the following do you feel is the "number three" problem for you as a couple, or for the family right now?

Number Three Problem? Dealing With The Ex(s) Money and Finances Parenting and Discipline Communication Trust Intimacy Recreation and Fun Visitation Holidays Other

When taken together, how bothersome are the problems you are currently having as a couple, or in your family right now? How Bothersome? Not bothersome at all A little bothersome Quite bothersome Very bothersome

.

 ~~~

Have you and/or your spouse ever taken a course on stepfamilies?

Taken Stepfamily Course? Yes, both of us have Yes, I have Yes, my spouse has No, neither of us has

If so, was it helpful?

Course Helpful? No Course Taken Yes, it was helpful No, it wasn't helpful

Have you and/or your spouse ever seen a counsellor regarding concerns with your present stepfamily?

Seen Counsellor? Yes, both of us have Yes, I have Yes, my spouse has No, neither of us has

.

If so, was it helpful?

Counselling Helpful? No Counselling Undertaken Yes, it was helpful No, it wasn't helpful

In as much detail as you feel is necessary, please describe, by typing in the box below, the kinds of difficulties you were having, or are currently having with parenting and discipline. Feel free to use examples if they will help.