1. Are you in a loving and nurturing relationship with your partner who has the same parenting goals?
a. Yes
b. No
c. I’m not sure

2. When it comes to children, I
a. Not sure that I am ready to have children
b. Don’t really like kids
c. I love them

3. Have you completed your educations?
a. I am still in school
b. I have achieved my educational goals
c. I didn’t finish my education and don’t plan on going back.

4. Are you healthy?
a. Yes, I am very healthy
b. No, I have been drinking and may be doing some level of drugs and am just not at my best healthy place.
c. I’m ok but I should make start making changes to become healthier.

5. Are you thinking about having kids?
a. Yes
b. Maybe someday
c. Never

6. How do you feel around children?
a. Calm and happy
b. Panic!!
c. No emotions

7. Which location is best to learn about parenting readiness?
a. Library (books and movies)
b. Parenting classes
c. Internet

8. Do you spend time with family?
a. Not unless I really have to.
b. Sometimes we see each other
c. I am with my family all the time

9. Do you have steady employment?
a. I have been employed at the same place for a long time
b. I go between jobs.
c. I only work when others can’t help support me

10. Are you financially ready?
a. Yes
b. It will be tough but I will be able to make it work
c. I have no idea how I am going to do this

11. How often do you drink, smoke , drugs?
a. Every week
b. When I’m stressed
c. Never

12. Do you have any spare time?
a. A few hours
b. I have a lot of spare time
c. I have no spare time at all

13. How do you feel about these questions?
a. Ok
b. Uncomfortable
c. Relaxed and comfortable

14. Which gender of the baby do you want?
a. Boy
b. Girl
c. Doesn’t matter

15. Do you and your partner share household chores equally?
a. The man does more
b. We share our chores equally
c. The woman does more

16. Do you own a house?
a. I do
b. I live with my parents
c. I have an apartment

17. How does pressure affect your mood?
a. I break super easily
b. I snap at people when under pressure
c. I do best when under pressure

18. Would your family members support and help you with raising your child?
a. Yes, they can’t wait for me to have kids
b. They say that they will help me but they aren’t necessarily happy about it.
c. I don’t think that they will ultimately help me.

19. How does the thought of becoming a parent make you feel?
a. It makes me very excited because this is what I had always wanted.
b. It makes me scared and nervous because I always wanted kids but am not sure that this was the time for me to have children.
c. I am absolutely feeling lost and scared.

20. Do you think that your partner will be a good parent?
a. Yes!! He/she will be the best mom/dad ever!
b. I’m not really sure.
c. I have serious concerns.

21. How would you discipline your child?
a. I would always treat them like an adult and =give them a reasonable punishment.
b. I would take away all of their favorite things and ground them.
c. I would be concerned on my skills in discipline because of the way I was disciplined.

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