Full Name

Phone *

Email *

How often do you and your partner discuss important matters (e.g., future plans, feelings, goals)? *

Frequently, we’re very open.

Sometimes, but it’s hard to bring things up.

Rarely, we avoid serious discussions.

When a disagreement arises, how do you resolve it? *

We talk it through calmly and find a solution together.

It depends on the situation; sometimes we argue, sometimes we resolve it.

We usually avoid talking or let the conflict linger.

How would you describe the level of physical and emotional intimacy in your relationship? *

Strong and fulfilling.

It’s okay but could be better.

We feel distant or disconnected.

Do you feel comfortable sharing your desires and boundaries with your partner? *

Yes, we are open and understanding.

Sometimes, but it’s awkward.

No, I feel judged or ignored.

How often do you spend meaningful time together without distractions (e.g., phones, work)? *

Regularly, we prioritize each other.

Occasionally, when we’re not busy.

Rarely, life gets in the way.

Do you have shared hobbies or activities you both enjoy? *

Yes, we have several things we love doing together.

A few, but not consistently.

No, we mostly do our own things.

When conflicts happen, how do they usually end? *

With mutual understanding and resolution.

With compromise, but not always satisfaction.

With one person feeling unheard or upset.

Do you revisit unresolved conflicts to address them later? *

Yes, we make it a point to sort things out.

Sometimes, but not always.

No, we prefer to move on without discussing.

How are household and relationship responsibilities shared? *

Fairly, we both contribute equally or in agreed-upon ways.

Unevenly, but we try to balance it out.

Very unevenly, one person does most of the work.

Do you and your partner discuss responsibilities regularly? *

Yes, we’re clear about who does what.

Occasionally, but it’s not consistent.

Rarely, we assume roles without talking.

How do you manage financial decisions in your relationship? *

Together, we plan and agree on expenses.

Sometimes together, but often independently.

Separately, we rarely discuss money matters.

Have financial disagreements caused significant stress in your relationship? *

Rarely, we’re aligned financially.

Occasionally, but we manage to move past it.

Frequently, it’s a major source of conflict.

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