1. I need to let you know that whenever you___________(do or say___), I feel ____________(name the exact feeling or feelings only);

2. In our relationship, I want us both to feel mutually___________(name the desired feeling/s only);

3. What I need in order to feel___________(name same desired feeling/s above only), I need you to _____________(name desired actions or words only);

4. Would you be willing to consider doing that and committing to that for me?