How Healthy is Your Relationship

You can always press Enter⏎ to continue

How Healthy is Your Relationship

1
Name
First Name
Last Name
2
EmailPlease enter your email so you can receive the results of this form. Please note, if you do not receive an email, please check your junk mail.
example@example.com
3
1.I feel physically safe with my partner:
Never
Sometimes
Often
Always
Unsure
4
2.My partner feels physically safe with me:
Never
Sometimes
Often
Always
Unsure
5
3.My emotional needs are met by my partner:
Never
Sometimes
Often
Always
Unsure
6
4.My physical needs (eg. food, shelter, clothing etc.) are met by my partner:
Never
Sometimes
Often
Always
Unsure
7
5.My sexual needs are met by my partner:
Never
Sometimes
Often
Always
Unsure
8
6.My partner and I work well as a team:
Never
Sometimes
Often
Always
Unsure
9
7.My partner knows what I need when I’m stressed:
Never
Sometimes
Often
Always
Unsure
10
8.My partner is good at communicating in my love language:
Never
Sometimes
Often
Always
Unsure
11
9.I respect my partner:
Never
Sometimes
Often
Always
Unsure
12
10.I appreciate my partner:
Never
Sometimes
Often
Always
Unsure
13
11.My partner respects me:
Never
Sometimes
Often
Always
Unsure
14
12.My partner appreciates me:
Never
Sometimes
Often
Always
Unsure
15
13.I need my partner:
Never
Sometimes
Often
Always
Unsure
16
14.My partner needs me:
Never
Sometimes
Often
Always
Unsure
17
15.I feel seen, heard and understood by my partner:
Never
Sometimes
Often
Always
Unsure
18
16.My partner feels seen, heard and understood by me:
Never
Sometimes
Often
Always
Unsure
19
17.We have many common interests and hobbies:
Never
Sometimes
Often
Always
Unsure
20
18.I meet my partner's emotional needs:
Never
Sometimes
Often
Always
Unsure
21
19.I meet my partner's physical needs (eg. food, shelter, clothing etc.):
Never
Sometimes
Often
Always
Unsure
22
20.I meet my partner's sexual needs:
Never
Sometimes
Often
Always
Unsure
23
21.My partner and I are good at communicating:
Never
Sometimes
Often
Always
Unsure
24
22.My partner and I are good at resolving conflict:
Never
Sometimes
Often
Always
Unsure
25
23.My partner and I share common goals for the future:
Never
Sometimes
Often
Always
Unsure
26
24.My partner and I share common values:
Never
Sometimes
Often
Always
Unsure
27
25.Even though things are sometimes challenging, I know I want to be with my partner long term:
Never
Sometimes
Often
Always
Unsure
28
Calculation* This field is required.
Should be Empty:

Question Label

1 of 28See AllGo Back