Leela with father 1979

Father-Daughter Relationship Questionnaire

You are being asked to fill out this questionnaire to support my research regarding father/daughter relationships, specifically the intimacy dynamic. I recognize that these questions ask very personal details regarding your relationship(s). Please know that your privacy and anonymity will be respected. Although I ask for your name and contact information, it is only so I can follow up with any additional questions I may have. Your name will not be published in association with this material unless you expressly give me permission to quote you. My intention is to create a book which will bring awareness to this crucial relationship and how it impacts all of our intimate relationships.

Optional Information

Your Name:

Your Email:

Your Phone Number:


Please answer the following questions.

If you have more than 1 father or daughter, please complete the questions for each separately.
Your answers will be held in the strictest of confidence.

1. Are you the  Father Daughter

2. Do you have more than 1 father or daughter?  Yes No
If yes, please complete and submit a separate form for each of your daughters/fathers.

3. What is your age?

4. What is your father/daughter’s age?

5. Are you physically affectionate with your father/daughter?  Yes No

Please describe the level of affection you share with him/her.

6. Have you ever discussed sex with your father/daughter?  Yes No

If yes, please describe the discussion, including answers to the following:

a) How old were you both at the time?

b) What level of detail was discussed?

c) How did you feel about the conversation then?

d) How do you feel about it now?

7. Have you ever felt desire for your father/daughter?  Yes No

a) If yes, what did you do with your desire at the time?

b) If yes, how did you feel about it then?

c) How do you feel about it now?

8. How would you describe your current relationship with him/her?

9. How do you feel this relationship has affected your other intimate relationships?

Thank you so much for taking the time to answer these questions. Please know that in doing so you are contributing to a project intended to bring awareness and healing to all that read my book.