Relationship Questionnaire
DO YOU HAVE A GREAT MARRIAGE? Please answer every question as it best describes you and your relationship today. Also, provide your name and contact information before clicking the "submit" button below. We will get back to you with an written evaluation of your relationship via email within 24 hours (48 hours on a weekend or holiday). All responses are held confidentially. It is important to include your city and state to identify any local relationship education resources in your area.
CHOOSE ONE RESPONSE FOR EACH QUESTION
1.
I feel safe being emotionally vulnerable with my partner
I feel safe being emotionally vulnerable with my partner2.I feel accepted by my partner for who I am
I feel accepted by my partner for who I am3.I can go to my partner for nonjudgmental support
I can go to my partner for nonjudgmental support4.My partner meets my needs
My partner meets my needs5.We are united in how we deal with money
We are united in how we deal with money6.We spend adequate time together away from work, the kids, TV and other distractions in life
We spend adequate time together away from work, the kids, TV and other distractions in life7.I feel connected with my partner
I feel connected with my partner8.My partner is a friend
My partner is a friend9.I feel appreciated by my partner
I feel appreciated by my partner10. I get the affection I need from my partner
11. My partner allows me to be who I am
12. I get the attention I need from my partner
13. Anger, bitterness, blame, hurt, criticism and resentment seldom are a part of our relationship
14. I feel heard and understood by my partner about things that are important to me
Your First Name
Partner's First Name
Your Email Address
City, State
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