Relationship Self-Assessment Questionnaire
Reflect on key aspects of your relationship to gain insight and identify areas for growth.
How satisfied are you with your current relationship overall?
*
1
2
3
4
5
Please rate the following aspects of your relationship:
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Communication
1
2
3
4
5
Trust
6
7
8
9
10
Conflict Resolution
11
12
13
14
15
Emotional Support
16
17
18
19
20
Physical Intimacy
21
22
23
24
25
How often do you and your partner spend quality time together?
*
Daily
Several times a week
Once a week
Rarely
Never
How comfortable do you feel discussing important issues with your partner?
*
1
2
3
4
5
How much do you trust your partner?
*
1
2
3
4
5
How would you describe the way conflicts are resolved in your relationship?
*
We resolve conflicts calmly and respectfully
We sometimes argue but usually resolve things
Conflicts often remain unresolved
We avoid discussing conflicts
Other
How supported do you feel by your partner emotionally?
*
1
2
3
4
5
How confident are you about the future of your relationship?
*
Very confident
Somewhat confident
Neutral
Somewhat doubtful
Very doubtful
What do you value most in your relationship?
Are there areas in your relationship you would like to improve? Please describe.
Submit Assessment
Should be Empty: