Reflective Functioning Questionnaire Scoring Form
Record and score responses for the Reflective Functioning Questionnaire in a standardized format.
Respondent Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Scorer's Full Name
*
First Name
Last Name
Scorer's Email Address
*
example@example.com
Reflective Functioning Questionnaire Items
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I find it difficult to understand my feelings.
1
2
3
4
5
People’s behavior can be confusing to me.
6
7
8
9
10
I can often guess what others are thinking.
11
12
13
14
15
I reflect on why I react the way I do.
16
17
18
19
20
I am aware of the motives behind my actions.
21
22
23
24
25
I struggle to understand why people do what they do.
26
27
28
29
30
I think about how my past affects my present feelings.
31
32
33
34
35
I can see situations from others’ perspectives.
36
37
38
39
40
Overall Reflective Functioning Score (if applicable)
Interpretation/Comments
Would you recommend further assessment based on this RFQ?
Yes
No
Not Sure
How confident are you in the accuracy of this scoring?
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Date Scored
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes (if any)
Submit Scoring
Should be Empty: