This is an original self-observation questionnaire, inspired by attachment theory (Bowlby, Ainsworth) and the related literature on care and affection. It is not identical to any commercially trademarked model; it uses its own wording and dimensions. Attachment theory describes two core functions of love: the “safe haven” (having someone there for me in difficult moments) and the “secure base” (someone who supports me so I can explore the world with confidence). On these, we express and receive love through five channels: words, acts, physical tenderness, time/presence, and emotional availability. For each channel, the test distinguishes how you GIVE from how you want to RECEIVE. When these two differ — or when you give far more easily than you allow yourself to receive — useful information emerges about your patterns in relationships. Instruction: “Answer based on how you generally function in your close relationships. There are no right or wrong answers.” This is a self-awareness tool, not a clinical diagnosis.