Romantic Feelings Reflection Survey
Take this survey to reflect on your romantic feelings and relationship experiences.
Your Age
*
Relationship Status
*
Single
In a relationship
Married
It's complicated
Other
How would you rate your current level of romantic feelings?
*
1
2
3
4
5
How satisfied are you with your current romantic relationship (or recent experience)?
*
Not satisfied
1
2
3
4
5
6
7
8
9
Very satisfied
10
1 is Not satisfied, 10 is Very satisfied
How often do you feel emotionally connected to your partner (or someone you have feelings for)?
*
Always
Often
Sometimes
Rarely
Never
Please indicate how much you agree with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel comfortable expressing my feelings.
1
2
3
4
5
I feel supported by my partner.
6
7
8
9
10
I am able to communicate openly.
11
12
13
14
15
I feel valued in my relationship.
16
17
18
19
20
What do you appreciate most about your romantic relationship or feelings?
What challenges do you currently face in your romantic feelings or relationship?
How often do you engage in activities that strengthen your romantic bond?
*
Daily
Several times a week
Once a week
Rarely
Never
What is one thing you would like to improve about your romantic life?
Would you like to share any additional thoughts or reflections?
Submit Reflection
Should be Empty: