Healthy Relationship Checklist
Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
N/A
Your Age
How long have you been together?
1
Rows
Yes
No
Notes
I feel loved.
2
3
I feel respected.
4
5
I feel acknowledged.
6
7
We discuss things regularly.
8
9
We disagree sometimes but usually reach a compromise.
10
11
We talk openly and honestly about most issues.
12
13
We negotiate on issues that are more important to one party.
14
15
My partner listens to me.
16
17
I am good at admitting it to my partner when I am wrong or have made a mistake.
18
19
My partner accepts responsibility when he/she has made a mistake and apologizes.
20
21
I can be myself when I am with my partner.
22
23
My partner has a good sense of humor.
24
25
It’s okay if we don’t agree sometimes.
26
27
My partner asks me how I feel.
28
29
My partner respects me.
30
31
My partner likes me the way I am and doesn’t try to change me.
32
33
My partner asks me what I think.
34
35
My partner wants me to succeed.
36
37
My partner is honest with me.
38
39
My partner admits to mistakes.
40
41
My partner sticks to our agreements.
42
43
Conflict drives us apart.
44
45
When I am tired I sometimes say hurtful things to my partner.
46
47
Our arguments are destructive to one or both parties.
48
49
My partner puts me down.
50
51
My partner insults me.
52
53
My partner blames me for everything that goes wrong.
54
55
My partner lies to me.
56
57
I feel on edge when I’m out with my partner, I can’t relax or unwind.
58
59
My partner cheats on me.
60
61
My partner lies about hurting me.
62
63
My partner makes important decisions without me.
64
65
My partner makes me do all the work.
66
67
My partner yells at me.
68
69
My partner sometimes hurts me physically.
70
71
My partner won’t let me see my friends.
72
73
My partner lies to me about money.
74
75
My partner takes all the money.
76
77
I can’t be myself when I am with my partner.
78
79
I don’t feel like my partner listens to me.
80
81
We often fight and lose our tempers.
82
83
My partner does not prioritize our relationship when they should.
84
85
My partner shares the work that supports us.
86
87
My partner trusts and supports me.
88
89
My partner loves me for who I am.
90
91
We communicate well.
92
93
We share equal responsibility for our relationship
94
95
We make time for each other.
96
97
We have similar friends and separate friends.
98
99
When we host friends, my partner helps do things that need to get done.
100
101
My partner thinks it’s okay when I spend time with my friends.
102
103
I feel strong in myself and not overshadowed by my partner.
104
105
My partner understands and accepts my family.
106
107
I am not insecure when my partner wants time alone.
108
109
We understand each other’s family dynamics.
110
111
My partner does nice things for me.
112
113
My partner believes in me.
114
115
My partner makes me feel safe.
116
117
We share responsibility for the practical things in life.
118
119
We remember important dates and events.
120
121
We take care of ourselves as well as each other.
122
123
We try to understand each other’s needs, desires
and expectations.
124
125
We genuinely like each other and love spending
time together.
126
127
We freely and openly express our love.
128
129
We are compassionate toward each other.
130
131
We share financial responsibility.
132
133
My partner doesn’t waste our money.
134
135
My partner is a good parent.
136
137
My partner helps the kids feel good about themselves.
138
139
We share parenting values.
140
141
We share parenting responsibilities.
142
143
My partner doesn’t think he/she is ever in the wrong.
144
145
My partner is inconsiderate of my needs.
146
147
My partner expects me to fall in with his/ her plans.
148
149
My partner never asks me about my day or my life.
150
151
My partner is not supportive of my parenting techniques.
152
153
My partner is uninvolved in our home and family life.
154
155
Given a choice, my partner wouldn’t choose to spend his / her free time with me and our children.
156
157
My partner is influenced heavily by what his / her friends think.
158
159
We do not have an intimate relationship as often
as we used to.
160
161
My partner doesn’t seem to find me attractive anymore.
162
163
Submit
Should be Empty: