Relationship Self-Assessment Questionnaire Form
Reflect on key aspects of your relationship with this concise self-assessment. Please answer each question honestly to gain meaningful insights.
Your Name or Identifier
*
First Name
Last Name
Current Relationship Status
*
Dating
Engaged
Married
Long-term Partnership
Other
How long have you been in this relationship?
*
Please Select
Less than 6 months
6 months to 1 year
1–3 years
3–5 years
More than 5 years
How would you rate the quality of communication in your relationship?
*
1
2
3
4
5
How much do you trust your partner?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
How effectively do you and your partner handle conflicts?
*
Not effectively
1
2
3
4
Very effectively
5
1 is Not effectively, 5 is Very effectively
How emotionally connected do you feel to your partner?
*
Not connected
1
2
3
4
Very connected
5
1 is Not connected, 5 is Very connected
How aligned are your goals and values with your partner’s?
*
Not aligned
1
2
3
4
Highly aligned
5
1 is Not aligned, 5 is Highly aligned
How supported do you feel by your partner?
*
Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
Overall, how satisfied are you with your relationship?
*
1
2
3
4
5
Submit Assessment
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