Relationship Check-In Form
Take a moment to reflect on your relationship and share your thoughts in this check-in poll.
Your Name
*
First Name
Last Name
Today's Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How satisfied are you with your relationship overall?
*
1
2
3
4
5
How would you rate communication with your partner recently?
*
1
2
3
4
5
What has been a recent highlight or positive experience in your relationship?
Are there any challenges or concerns you'd like to share?
How supported do you feel by your partner?
*
Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
How much quality time have you spent together recently?
*
A lot
Some
A little
None
What is one thing you appreciate about your partner right now?
Is there anything you'd like to work on or set as a goal together?
Submit Check-In
Should be Empty: