the experiences in close relationships-revised questionnaire
Fraley, Waller, and brennan (2000)

Please complete the following questionnaire. Upon submission, your responses will be provided to your clinician.

The statements below concern how you feel in emotionally intimate relationships. We are interested in how you generally experience relationships, not just what is happening in a current relationship. Respond to each statement by selecting a number to indicate how much you agree or disagree with the statement, using the following scale:

1 = Strongly Disagree 2 = Disagree 3 = Somewhat Disagree 4 = Neutral

5 = Somewhat Agree 6 = Agree 7 = Strongly Agree

Name *
Please enter the name of the clinician who requested that you complete the questionnaire.