Couples Survey

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Couples Survey

1
Your Age
2
Your Partners Age
3
Your Annual Income
Less than $25000
$25000 – $49999
$50000 – $74999
$75000 – $99999
$100000 – $200000
$200000
4
Your Partners Annual Income
Less than $25000
$25000 – $49999
$50000 – $74999
$75000 – $99999
$100000 – $200000
$200000
5
Your Highest Level of Education
Less than high school
High School
College
Graduate School
Post Graduate School
6
Partners Highest Level of Education
Less than high school
High School
College
Graduate School
Post Graduate School
7
What is your relationship status?
Married
Not Married
8
How many years have you been together?
Less than a year
1 - 3 years
3 - 5 years
5 - 10 years
10 - 20 years
20 or more years
9
How satisfied are you with your partners emotional support?
1
2
3
4
5
10
How satisfied you are with the respect and admiration received from your partner?
1
2
3
4
5
11
How satisfied are you with your partners financial support?
1
2
3
4
5
12
How satisfied are you with your sex life?
1
2
3
4
5
13
How satisfied are you with the time you spend together with your partner?
1
2
3
4
5
14
How often do you argue about the following reasons?
Daily
Weekly
Monthly
Rarely
Never
Money
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Friends
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Parents
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Household chores
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Children / Pets
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Phone Usage
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Responsibilities
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Time Spent Together
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Intimacy
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Row 8, Column 3
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Each Others Appearance
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Money
Friends
Parents
Household chores
Children / Pets
Phone Usage
Responsibilities
Time Spent Together
Intimacy
Each Others Appearance
Daily
Row 0, Column 0
Weekly
Row 0, Column 1
Monthly
Row 0, Column 2
Rarely
Row 0, Column 3
Never
Row 0, Column 4
Daily
Row 1, Column 0
Weekly
Row 1, Column 1
Monthly
Row 1, Column 2
Rarely
Row 1, Column 3
Never
Row 1, Column 4
Daily
Row 2, Column 0
Weekly
Row 2, Column 1
Monthly
Row 2, Column 2
Rarely
Row 2, Column 3
Never
Row 2, Column 4
Daily
Row 3, Column 0
Weekly
Row 3, Column 1
Monthly
Row 3, Column 2
Rarely
Row 3, Column 3
Never
Row 3, Column 4
Daily
Row 4, Column 0
Weekly
Row 4, Column 1
Monthly
Row 4, Column 2
Rarely
Row 4, Column 3
Never
Row 4, Column 4
Daily
Row 5, Column 0
Weekly
Row 5, Column 1
Monthly
Row 5, Column 2
Rarely
Row 5, Column 3
Never
Row 5, Column 4
Daily
Row 6, Column 0
Weekly
Row 6, Column 1
Monthly
Row 6, Column 2
Rarely
Row 6, Column 3
Never
Row 6, Column 4
Daily
Row 7, Column 0
Weekly
Row 7, Column 1
Monthly
Row 7, Column 2
Rarely
Row 7, Column 3
Never
Row 7, Column 4
Daily
Row 8, Column 0
Weekly
Row 8, Column 1
Monthly
Row 8, Column 2
Rarely
Row 8, Column 3
Never
Row 8, Column 4
Daily
Row 9, Column 0
Weekly
Row 9, Column 1
Monthly
Row 9, Column 2
Rarely
Row 9, Column 3
Never
Row 9, Column 4
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15
How fast are your relationship issues resolved or forgiven?
Immediately
Next day
At least a week
Always hold a grudge
16
From 1 to 10 how would you rate your relationship?
1
2
3
4
5
6
7
8
9
10
Should be Empty:

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