Relationship Reflection Survey
Take this survey to thoughtfully reflect on different aspects of your relationship and identify areas of strength and growth.
Your Name (Optional)
First Name
Last Name
How long have you been in your current relationship?
*
Please Select
Less than 6 months
6 months to 1 year
1 to 3 years
3 to 5 years
More than 5 years
Overall, how satisfied are you with your relationship?
*
1
2
3
4
5
Please rate the following aspects of your relationship:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Communication
1
2
3
4
5
Trust
6
7
8
9
10
Emotional Support
11
12
13
14
15
Conflict Resolution
16
17
18
19
20
Quality Time Together
21
22
23
24
25
How do you and your partner typically resolve disagreements?
*
We communicate openly and resolve issues together
We sometimes avoid the issue
One person usually gives in
Arguments often remain unresolved
Other
Which of the following do you feel are strengths in your relationship? (Select all that apply)
*
Communication
Trust
Emotional Support
Shared Interests
Respect
Intimacy
Problem Solving
Other
How often do you and your partner spend quality time together?
*
Daily
Several times a week
Once a week
A few times a month
Rarely
On a scale of 1 to 10, how comfortable do you feel expressing your feelings to your partner?
*
Not comfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Not comfortable, 10 is Very comfortable
What is one thing you appreciate most about your partner?
What is one area you would like to improve in your relationship?
Would you recommend relationship reflection surveys to others?
*
Yes
No
Submit Reflection
Should be Empty: