Toxic Relationship Assessment
Evaluate key aspects of your relationship to identify potential toxic patterns.
Your full name (optional)
First Name
Last Name
Your relationship to the person being assessed
*
Please Select
Romantic Partner
Spouse
Ex-Partner
Friend
Family Member
Other
How long have you been in this relationship?
*
Please Select
Less than 6 months
6 months to 1 year
1-3 years
More than 3 years
How often do you feel respected by this person?
*
1
2
3
4
5
How often do you feel controlled or manipulated by this person?
*
1
2
3
4
5
Please indicate how much you agree with the following statements about your relationship.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel safe expressing my opinions.
1
2
3
4
5
My boundaries are respected.
6
7
8
9
10
Arguments are resolved in a healthy way.
11
12
13
14
15
There is trust between us.
16
17
18
19
20
I feel supported in my goals.
21
22
23
24
25
Has this person ever isolated you from friends or family?
*
Never
Rarely
Sometimes
Often
Always
Do you feel anxious or fearful about this person’s reactions?
*
Never
Rarely
Sometimes
Often
Always
Does this person apologize and make amends after a conflict?
*
Never
Rarely
Sometimes
Often
Always
In your own words, describe any concerns or patterns you have noticed in your relationship.
Submit Assessment
Should be Empty: