Toxic Relationship Testing Form

Toxic Relationship Test Form

measures symptoms and severities
Does the same type of negative relationship experience keep happening to you?

YesNoOther
Are any of your relationships painful in some way?

YesNoOther
Do you ever feel abused?

YesNoOther
Do you argue and make up with the same person often?

YesNoOther
Do you ever make empty promises to someone else?

YesNoOther
Do you ever stay quiet to keep the peace?

YesNoOther
Do you have a lot of repressed anger?

YesNoOther
Does anyone you know say insulting things in a nice way?

YesNoOther
Do you tell someone what they want to hear, instead what you really feel?

YesNoOther
Are you frightened for your safety with certain people?

YesNoOther
Is someone being abusive to you daily?

YesNoOther
Are you in a relationship with someone with a substance abuse problem?

YesNoOther
Do you have a substance abuse issue?

YesNoOther
Does it seem like you are the only one who ever changes in a relationship?

YesNoOther
Do you ever manipulate someone to get what you want from them?

YesNoOther
Are your silently angry at someone?

YesNoOther
Do it feel like someone owes you something?

YesNoOther
Is there someone who points out your flaws, picks on you, or jokes or pushes your boundaries?

YesNoOther
Do you look out for others as much as you do yourself?

YesNoOther
Are you tired of needy clingy people?

YesNoOther
Does someone depend on you for any of their needs?

YesNoOther
Do you depend on someone else for any of your needs?

YesNoOther
Are you afraid to leave a situation or person because of how much you will lose?

YesNoOther
Who are you willing to discuss your results with? (if other, please add their name and email address)

Jeff RoundsSelyna BreezeOther
If you are in a dangerous situation, please get the help you need, contact:

National Domestic Violence Hotline
Name

First NameLast Name
Email
example@example.com
By submitting I hereby confirm that the information I have given above is true, and that I will be receiving an email response to my submission and an invitation to discuss the results with a nonprofessional.
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Toxic Relationship Test Form