Family Communication Assessment Survey
Please complete this survey to help us understand and improve communication patterns within your family.
Your Full Name
*
First Name
Last Name
Your Role in the Family
*
Please Select
Parent/Guardian
Child/Teenager
Grandparent
Other
How many members are in your immediate family?
*
How often does your family have conversations together?
*
Multiple times a day
Once a day
A few times a week
Rarely
Never
Please rate the following aspects of your family communication:
*
Rows
Never
Rarely
Sometimes
Often
Always
We listen to each other without interrupting
1
2
3
4
5
We express our feelings openly
6
7
8
9
10
We resolve conflicts calmly
11
12
13
14
15
We respect each other's opinions
16
17
18
19
20
We support each other during difficult times
21
22
23
24
25
Overall, how satisfied are you with communication in your family?
*
1
2
3
4
5
How comfortable do you feel sharing personal concerns with your family?
*
Not comfortable at all
1
2
3
4
5
6
7
8
9
Extremely comfortable
10
1 is Not comfortable at all, 10 is Extremely comfortable
What communication methods does your family use most often? (Select all that apply)
*
Face-to-face conversation
Phone calls
Text messages
Group chats/apps
Emails
Other
What is one thing you wish would improve about communication in your family?
Submit Survey
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