Relationship Improvement Survey
Please complete the Relationship Improvement Survey Form to help us understand relationship dynamics and identify areas for growth.
How would you rate the overall communication in your relationship?
*
1
2
3
4
5
How much do you agree with the following statement: "We trust each other completely."
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
How satisfied are you with the amount of quality time spent together?
*
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
How often do conflicts or disagreements occur in your relationship?
*
Very frequently
Frequently
Occasionally
Rarely
Never
Please indicate how much you agree with the following statements about your relationship.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
We resolve conflicts in a healthy way.
1
2
3
4
5
We support each other's goals.
6
7
8
9
10
We feel emotionally connected.
11
12
13
14
15
How comfortable do you feel expressing your feelings to your partner?
*
Not at all comfortable
1
2
3
4
Extremely comfortable
5
1 is Not at all comfortable, 5 is Extremely comfortable
Which area do you feel needs the most improvement in your relationship?
*
Please Select
Communication
Trust
Quality time
Conflict resolution
Emotional support
Other
How likely are you to recommend relationship counseling or workshops to others?
*
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
How do you prefer to resolve disagreements?
*
Open discussion
Taking a break and returning to the issue
Avoiding the topic
Seeking outside help
Other
What is one thing you believe would most improve your relationship?
*
Submit Survey
Should be Empty: