Relationship Survey
How long have you been in this relationship?
how would you rate the quality of communication in your relationship?
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
What are the main ways you and your partner communicate?
(in-person, phone, text, etc.)
Are there any communication challenges you've encountered?
How often do you and your partner spend quality time together?
(e.g., date nights, shared activities)
Are you satisfied with the amount of quality time you spend together?
Yes
No
how would you rate the level of intimacy in your relationship?
Low
1
2
3
4
High
5
1 is Low, 5 is High
Are there any specific aspects of intimacy that need improvement or that you're particularly satisfied with?
How do you and your partner typically resolve conflicts or disagreements?
Are there recurring issues that you find challenging to resolve?
Do you feel a high level of trust and honesty in your relationship?
Yes
No
Are there any trust issues or concerns you'd like to address?
Do you and your partner share common goals and values for the future?
Yes
No
Are there significant differences in your life goals or values?
Yes
No
How do you and your partner support and appreciate each other in your daily lives?
How satisfied are you with your relationship?
Not Satisfied
1
2
3
4
Extremely Satisfied
5
1 is Not Satisfied, 5 is Extremely Satisfied
What aspects of the relationship contribute to your satisfaction, and what could be improved?
Is there anything else you'd like to share about your relationship or any specific concerns or aspirations?
Submit
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