Family Orientation Survey
Help us understand your family's values, communication, and needs. Please answer the following questions honestly.
Family Contact Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How many people are in your household?
*
Please indicate the relationship of each family member living in your household.
*
How would you describe your family's communication style?
*
Open and frequent
Occasional and focused
Reserved or private
Other
How often does your family spend quality time together?
*
Daily
Several times a week
Once a week
Rarely
Please rate your agreement with the following statements about your family.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
We support each other's goals.
1
2
3
4
5
We resolve conflicts respectfully.
6
7
8
9
10
We value spending time together.
11
12
13
14
15
We communicate openly about feelings.
16
17
18
19
20
Which values are most important to your family? (Select up to 3)
*
Respect
Honesty
Kindness
Responsibility
Education
Faith/Spirituality
Other
What challenges does your family currently face? (Select all that apply)
Time management
Work-life balance
Communication difficulties
Financial concerns
Health issues
Other
How interested are you in participating in family-oriented programs or workshops?
Not interested
1
2
3
4
Very interested
5
1 is Not interested, 5 is Very interested
Please share any additional comments or information that would help us better understand your family.
Submit Survey
Should be Empty: