Oregon Marital Assessment Service

Formerly Oregon Marital Studies Program

Order Form for Assessment Services

Couples Assessment Instruments

Includes forms for each partner, instructions, scoring sheets and samples when applicable.

Unit = complete set for two individuals

1-5 6-15 Quantity Total Price

Areas of Change Questionnaire (ACQ) 6.50 4.50 _______ ________

Inventory of Rewarding Activities (IRA) 5.00 4.50 _______ ________

Marital Status Inventory (MSI) 3.00 2.50 _______ ________

Marital Strengths and Weakness 3.00 2.50 _______ ________

Spouse Observation Checklist (SOC) 6.50 5.50 _______ ________

Spouse Observation Rating Form 1.75 1.50 _______ ________

Coding Manuals

MICS-IV Manual 10.00 _______ ________

MICS-S Manual 8.00 _______ ________

Couple’s Work Book

Interactive Couples Therapy: A Couple’s Guide $25.00 _______

by Barbara Ann Perry, Ph.D. & Robert L. Weiss, Ph.D.

Contains self-assessment exercises and homework options suitable for couples use under therapist directions

Add 5% of total amount for shipping and handling ________
TOTAL AMOUNT ENCLOSED (U.S. CURRENCY PLEASE) ……… ________

Payable to: Dr. Robert L. Weiss Oregon Marital Assessment Service 3003 Willamette Street Suite  F Eugene, OR 97405 USA

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