1 | □ | I like to receive notes of affirmation. | A |
| □ | I like to be hugged. | E |
2 | □ | I like to spend one-to-one time with a person who is special to me. | B |
| □ | I feel loved when someone gives practical help to me. | D |
3 | □ | I like it when people give me gifts. | C |
| □ | I like leisurely visits with friends and loved ones. | B |
4 | □ | I feel loved when people do things to help me. | D |
| □ | I feel loved when people touch me. (e.g. a pat on the shoulder for encouragement) | E |
5 | □ | I feel loved when someone I love or admire puts his or her arm around me. | E |
| □ | I feel loved when I receive a gift from someone I love or admire. | C |
6 | □ | I like to go places with friends and loved ones. | B |
| □ | I like to high-five or hold hands with people who are special to me. | E |
7 | □ | Visible symbols of love (gifts) are very important to me. | C |
| □ | I feel loved when people affirm me. | A |
8 | □ | I like to sit close to and get into deep conversation with people whom I enjoy being around. | E |
| □ | I like to hear people telling me I am pretty, charming or handsome. | A |
9 | □ | I like to spend time with friends and loved ones. | B |
| □ | I like to receive little gifts from friends and loved ones. | C |
10 | □ | Words of acceptance are important to me. | A |
| □ | I know someone loves me when he or she helps me. | D |
11 | □ | I like being together and doing things with friends and loved ones. | B |
| □ | I like it when kind words are spoken to me. | A |
12 | □ | What someone does affects me more than what he or she says. | D |
| □ | Hugs make me feel connected and valued. | E |
13 | □ | I value praise and try to avoid criticism. | A |
| □ | Several small gifts mean more to me than one large gift. | C |
14 | □ | I feel close to someone when we are talking or doing something together. | B |
| □ | I feel closer to friends and loved ones when they touch me often. (e.g. give a high-five, pat on the shoulder or hold hands, etc.) | E |
15 | □ | I like it when people compliment my achievements. | A |
| □ | I know people love me when they do things for me that they don't enjoy doing. | D |
16 | □ | I like to be touched as friends and loved ones walk by. | E |
| □ | I like it when people listen to me and show genuine interest in what I am saying. | B |
17 | □ | I feel loved when friends and loved ones help me with jobs or projects. | D |
| □ | I really enjoy receiving gifts from friends and loved ones. | C |
18 | □ | I like it when people compliment my appearance. | A |
| □ | I feel loved when people take time to understand my feelings. | B |
19 | □ | I feel secure when a special person hugs me or holds my hands. | E |
| □ | Acts of service make me feel loved. | D |
20 | □ | I appreciate the many things that special people do for me. | D |
| □ | I like receiving gifts from people who are special to me. | C |
21 | □ | I really enjoy the feeling I get when someone pampers me (to be in someone's thoughts). | B |
| □ | I really enjoy the feeling I get when someone serves me (helping through action). | D |
22 | □ | I feel loved and treasured when a person celebrates my birthday with a gift. | C |
| □ | I feel loved when a person celebrates my birthday with meaningful words. | A |
23 | □ | I know a person is thinking of me when he or she gives me a gift. | C |
| □ | I feel loved when a person helps me with my household chores. | D |
24 | □ | I appreciate it when someone listens patiently and doesn't interrupt me. | B |
| □ | I appreciate it when someone remembers special days with a gift. | C |
25 | □ | I like knowing loved ones are concerned enough to help with my daily household tasks or buying bread, etc. | D |
| □ | I enjoy going out and going on extended trips with someone who is special to me. | B |
26 | □ | I like holding hands, hugging and patting on the shoulder with people whom I am close to. | E |
| □ | I enjoy receiving a gift given for no special reason. | C |
27 | □ | I like to be told that I am being appreciated. | A |
| □ | I like people looking at me when we are talking. | B |
28 | □ | Gifts from a friend or loved one are always special to me. | C |
| □ | I feel good when a friend or loved one touches me. | E |
29 | □ | I feel loved when a person enthusiastically does some tasks I have requested. | D |
| □ | I feel loved when I am told how much I am appreciated. | A |
30 | □ | I need to be touched every day（e.g. hugging when leaving each other or meeting up） | E |
| □ | I need words of affirmation every day（e.g. people express gratitude for my effort and hard work） | A |
