A

B

C

D

E

1.

I like to receive notes of affirmation from you.

I like it when you hug me.

X

X

2.

I like to spend one-on-one time with you.

I feel loved when you give practical help to me.

X

X

3.

I like it when you give me gifts.

I like taking long walks with you.

X

X

4.

I feel loved when you do things to help me.

I feel loved when you touch me.

X

X

5.

I feel loved when you hold me in your arms.

I feel loved when I receive a gift from you.

X

X

6.

I like to go to places with you.

I like to hold hands with you.

X

X

7.

Visible symbols of love (gifts) are very important to me.

I feel loved when you affirm me.

X

X

8.

I like to sit close to you.

I like for you to tell me I am attractive/handsome.

X

X

9.

I like to spend time with you.

I like to receive little gifts from you.

X

X

10.

Your words of acceptance are important to me.

I know you love me when you help me.

X

X

11.

I like to be together when we do things.

I like the kind words you say to me.

X

X

12.

What you do affects me more than what you say.

I feel whole when we hug.

X

X

13.

I value your praise and try to avoid your criticism.

Several inexpensive gifts from you mean more to me than one large gift.

X

X

14.

I feel close when we are talking or doing something together.

I feel closer to you when you touch me often.

X

X

15.

I like for you to compliment my achievements.

I know you love me when you do things for me that you don’t enjoy doing.

X

X

16.

I like for you to touch me when you walk by.

I like it when you listen to me sympathetically.

X

X

17.

I feel loved when you help me with my jobs around the house.

I really enjoy receiving gifts from you.

X

X

18.

I like for you to compliment my appearance.

I feel loved when you take time to understand my feelings.

X

X

19.

I feel secure when you are touching me.

Your acts of service make me feel loved.

X

X

20.

I appreciate the many things you do for me.

I like receiving gifts that you make.

X

X

21.

I really enjoy the feeling I get when you give me your undivided attention.

I really enjoy the feeling I get when you do some acts of service.

X

X

22.

I feel loved when you celebrate my birthday with a gift.

I feel loved when you celebrate my birthday with meaningful words (written or spoken).

X

X

23.

I know you are thinking of me when you give me a gift.

I feel loved when you help out with the chores.

X

X

24.

I appreciate it when you listen patiently and don’t interrupt me.

I appreciate it when you remember special days with a gift.

X

X

25.

I like to know you are concerned enough to help with my daily tasks.

I enjoy extended trips with you.

X

X

26.

Kissing me unexpectedly excites me.

Giving me a gift for no special occasion excites me.

X

X

27.

I like to be told that you appreciate me.

I like for you to look at me when we are talking.

X

X

28.

Your gifts are always special to me.

I feel good when you are touching me.

X

X

29.

I feel loved when you enthusiastically do some task I have requested.

I feel loved when you tell me how much you appreciate me.

X

X

30.

I need to be touched every day.

I need your words of affirmation daily.

X

X