Relationship Assessment for Couples

This confidential online 77-question assessment will provide a comprehensive review of the important areas of your relationship along with general recommendations for discussion and goal-setting with your partner. Please fill out individually. This assessment should take you between 15-20 minutes to complete.

My non-negotiable requirements are met in this relationship.*
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My vision for life is supported in this relationship.*
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My life purpose and mission are supported in this relationship.*
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I am willing to live the rest of my life with everything exactly the way it is in this relationship.*
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I am not settling for less than what I really want in this relationship.*
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We are in alignment regarding money.*
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We are in alignment regarding future plans.*
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We are in alignment regarding children and family.*
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I trust my partner to be successfully faithful.*
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I trust my partner with our/my money.*
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I trust my partner to be honest with me about everything.*
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I trust my partner to keep agreements in our relationship.*
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I can see myself growing old and happy in this relationship.*
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I feel physically safe in this relationship.*
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We are in alignment regarding lifestyle.*
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We have successfully adjusted to having different food preferences and eating habits.*
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I am satisfied with our health habits and practices.*
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I am satisfied with our grooming and hygiene habits and practices.*
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I am satisfied with our hobbies, physical and leisure activities.*
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I am satisfied with our level of desire for travel and adventure.*
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We are well matched in our preferences to stay home and have quiet times.*
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We travel well together.*
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I am supported to pursue my own interests/activities in this relationship.*
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Our families support our relationship.*
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Our friends support our relationship.*
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I am satisfied with our preferences for socializing with friends and family.*
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We both have individual support systems.*
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We seek support when we need it.*
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I feel loved in this relationship.*
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I feel good about myself in this relationship.*
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This relationship brings out the best in me.*
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I feel emotionally safe in this relationship.*
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I feel able to be myself in this relationship.*
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I feel respected for who I am in this relationship.*
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We have equal levels of give and take in this relationship.*
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I have fun and laugh in this relationship.*
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This relationship feels equal on all levels.*
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We enjoy small moments of connection each day no matter how busy we are.*
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We are in alignment regarding religious and/or spiritual beliefs and practices.*
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I am satisfied with how we live our values in our life together.*
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I am satisfied with how we plan to make a difference in the world.*
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We support each other's hopes, dreams and aspirations.*
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We recognize and support each other's "essence" in times of stress.*
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Our communication is effective*
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We manage our differences positively and without conflict.*
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I am able to be totally honest in this relationship.*
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We handle stress effectively together.*
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We handle differences and conflict effectively without "fight" or "flight."*
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We are able to soothe ourselves and each other during tense situations.*
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We are able to live positively with our unresolvable differences.*
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We respect each other's feelings and reactions during a conflict.*
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We regularly discuss small frustrations and irritations so that they do not get larger.*
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We try to make things better during or after a conflict.*
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We forgive each other and don't hold on to resentments.*
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We are in alignment about pets*
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We are in alignment about how to handle kids.*
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We are in agreement about who does what around your home whether it is "pink" or "blue" jobs.*
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We are in alignment regarding our level of organization and neatness around our home.*
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We share equally in caring for our home.*
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I experience strong chemistry in this relationship.*
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I experience passion in this relationship.*
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I experience romance in this relationship.*
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I find my partner very attractive.*
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I get turned on with my partner.*
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I know what turns on my partner.*
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We talk about our sexual preferences.*
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I am fulfiled sexually in this relationship.*
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I am satisfied intelluctually in this relationship.*
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I am satisfied emotionally in this relationship.*
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I am satisfied with the level of maturity in this relationship.*
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We know and accept each other's quirks.*
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We intimately know each other's likes and dislikes, hopes and dreams and have created a vision for our life together.*
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We stimulate positive growth and learning for each other.*
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Name*
First Last
Email*

*Used by permission from the Relationship Coaching Insitute.