Marital Relationship Habits Questionnaire
Please answer the following questions to help us understand your relationship habits and experiences. Your responses are confidential and will be used for assessment purposes only.
Your Full Name
*
First Name
Last Name
How long have you been married?
*
Please Select
Less than 1 year
1-3 years
4-7 years
8-15 years
More than 15 years
How often do you and your spouse communicate openly about your feelings?
*
Daily
A few times a week
Once a week
Rarely
How satisfied are you with the emotional support you receive from your spouse?
*
1
2
3
4
5
Please rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
We spend quality time together regularly.
1
2
3
4
5
We resolve conflicts in a healthy manner.
6
7
8
9
10
We share household responsibilities fairly.
11
12
13
14
15
We support each other's personal growth.
16
17
18
19
20
How often do you and your spouse participate in shared activities (e.g., hobbies, outings, or projects)?
*
Several times a week
Once a week
A few times a month
Rarely
How do you and your spouse typically resolve disagreements?
*
Open discussion
Avoidance
Compromise
Third-party mediation
Other
On a scale of 1 to 10, how satisfied are you with your overall marital relationship?
*
Not satisfied
1
2
3
4
5
6
7
8
9
Extremely satisfied
10
1 is Not satisfied, 10 is Extremely satisfied
Do you and your spouse have regular date nights or special time together?
*
Yes, weekly
Yes, monthly
Occasionally
Rarely/Never
Please share any additional comments or insights about your marital relationship habits.
Submit
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