Additional Family Questions
Answers marked with a * are required.
I am interested in family patterns of estrangement and I would appreciate your contribution to further our understanding of this issue. If you took my original survey "Parents Estranged from Adult Children" or "Adult Children Estranged from Parents", please check off where appropriate. If you did not, I am also interested in your answers to this brief questionnaire.
1.
At any point in your family history, were you ever:
Check all that apply
*
Estranged from mother
Estranged from father
Estranged from sibling(s)
Other
2.
At any point in your significant other's family history, were they ever estranged from:
(this question applies to anyone involved with your children.. whether it be an ex or a step)
Check all that apply
*
Estranged from mother
Estranged from father
Estranged from sibilings
Other
3.
Were these estrangements ever resolved?
*
Yes
No
Other (Please Specify)
4.
If you are currently estranged, please check all that apply:
*
Mother
Father
Daughter/s
Son/s
Step Daughter/s
Step Son/s
Brother/s
Sister/s
Mother in Law
Father in Law
Sister/s in Law
Brother/s in Law
Other (Please Specify)
5.
To keep this extra questionnaire on track:
*
Male
Female
6.
What is your current income bracket?
Please select from the following:
*
20,000 - 29,000
30,000 - 39,000
40,000 - 49,000
50,000 - 59,000
60,000 - 69,000
70,000 - 79,000
80,000 - 89,000
90,000 - 99,000
100,000 - 125,000
over 125,000
7.
Please select the group that best represents your age:
*
20 - 29
30 - 39
40 - 49
50 - 60
over 60
8.
Did you participate in the previous survey?
If so, please select which one:
*
Parents Estranged from Adult Children
Adult Children Estranged from Parents
Neither
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