Relationship Satisfaction Survey
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What is your gender?
Female
Male
Other
How old are you?
How many years do you know each other?
On scale strongly disagree to strongly agree, how much do you agree with the following situations;
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel close to my partner.
1
2
3
4
5
My partner cares about me.
6
7
8
9
10
I feel confident that we can deal with whatever problems might come up in our relationship.
11
12
13
14
15
I consider myself happy in our relationship.
16
17
18
19
20
My partner usually listens to me.
21
22
23
24
25
Please choose true or false according to the following situations;
Rows
True
False
Our home life together feels comfortable and fun.
26
27
There is a sense of peace in our life together.
28
29
I am not able to function well in my own life while I am in this relationship.
30
31
Unplanned negative events keep happening to us.
32
33
We always have to adapt to changing circumstances.
34
35
Our arguments seem to come up out of nowhere.
36
37
My partner brings up issues abruptly or with poor timing.
38
39
I find my partner's negativity unsettling.
40
41
I look forward to reunions with my partner at the end of each day.
42
43
I often seem to get blamed for issues.
44
45
My partner criticizes my personality.
46
47
I look forward to our vacations and enjoy the travel we do together.
48
49
When we do errands together, we usually have a good time.
50
51
We don’t agree on how to handle our money.
52
53
Submit
Should be Empty: