Love Feelings Self-Assessment Survey Form
Reflect on your current romantic feelings, emotional readiness, and relationship preferences. Please answer honestly for your own self-awareness.
How would you describe your current romantic feelings?
*
In love
Interested in someone
Open to new connections
Not currently interested
How ready do you feel for a new romantic relationship?
*
Not ready
1
2
3
4
Very ready
5
1 is Not ready, 5 is Very ready
Rate your overall satisfaction with your current love life.
*
1
2
3
4
5
Which best describes your current relationship status?
*
Single
In a relationship
It's complicated
Prefer not to say
How important are the following factors to you in a relationship?
*
Rows
Not important
Somewhat important
Very important
Emotional connection
1
2
3
Shared values
4
5
6
Physical attraction
7
8
9
Communication
10
11
12
Personal growth
13
14
15
How often do you think about starting or deepening a romantic relationship?
*
Daily
Weekly
Occasionally
Rarely
How confident do you feel expressing your feelings to someone you care about?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which of the following best matches your current relationship goals?
*
Looking for a serious relationship
Interested in casual dating
Open to possibilities
Prefer to be single
How do you feel about your ability to maintain healthy boundaries in romantic relationships?
*
Needs improvement
1
2
3
4
Excellent
5
1 is Needs improvement, 5 is Excellent
How satisfied are you with your current level of self-love and self-acceptance?
*
1
2
3
4
5
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