Dyadic Adjustment Scale survey for couples

Please Enter Your Full Name* This field is required.*Please note: You and your partner should take this assessment separately.

First Name

Last Name

Enter the name of your ServingLeaders counselor * This field is required.*Note: This counselor will receive a copy of your survey results.

Questions 1-15* This field is required.Respond to each of the following statements.

Questions 16-22* This field is required.Respond to each of the following statements.

Questions 23-26* This field is required.Respond to how frequently the following events occur between you and your partner.

Question 27: Which of the following statements best describes how you feel about the future of your relationship?* This field is required.

I want desperately for my relationship to succeed and would go to almost any length to see that it does.

I want very much for my relationship to succeed and will do all I can to see that it does.

I want very much for my relationship to succeed and will do my fair share to see that it does.

It would be nice if my relationship succeeded but I refuse to do any more than I am doing now to keep the relationship going.

My relationship can never succeed and there is no more than I can do to keep the relationship going.

Questions 28 & 29: Indicate if either of the items below caused differences of opinion or were problems in your relationship during the past few weeks.* This field is required.

Question 30: How many outside interests do you and your partner engage in together?* This field is required.

All of them

Most of them

Some of them

Very few of them

None of them

Question 31: What is the overall degree of happiness - all things considered - that best describes your relationship?* This field is required.

Extremely Happy

Very happy

Happy

Fairly unhappy

Extremely unhappy

Question 32: How often do you kiss your partner?* This field is required.

Every day

Almost every day

Occasionally

Rarely

Never