| Example: | Yes | No | |
| 1. Are you satisfied with your family? ................ | [X] | [ ] | |
| 2. Are you satisfied with your career? ............... | [X] | [ ] | |
| 3. Are you satisfied with your marriage? ............ | [X] | [ ] |
| Example: | Yes | No | |
| 1. Are you satisfied with your family? ................ | [X] | [ ] | |
| 2. Are you satisfied with your career? ............... | [X] | [ ] | |
| 3. Are you satisfied with your marriage? ............ | [X] | [ ] |