Couple's Relationship Health Questionnaire

  • Couple's Relationship Health Questionnaire

    Questionnaire designed for couples to assess their relationship’s intimacy, communication skills, values alignment, love languages, and overall strength.

  • Section 1: Intimacy

  • Emotional Intimacy: How often do you feel emotionally connected to your partner?
  • Emotional Intimacy: How comfortable are you sharing your innermost thoughts and feelings with your partner?
  • Emotional Intimacy: Do you feel that your partner understands your emotions and supports you during difficult times?
  • Physical Intimacy: How satisfied are you with the level of physical affection in your relationship? (Hugs, cuddles, kisses, etc.)
  • Physical Intimacy: How often do you and your partner engage in physical intimacy (including sexual connection)?

  • Section 2: Communication Skills

  • Active Listening: How often do you feel that your partner listens to you without interrupting or judging?
  • Active Listening: Do you feel comfortable voicing your needs, thoughts, and concerns in your relationship?
  • Conflict Resolution: How well do you and your partner resolve conflicts or disagreements?
  • Conflict Resolution: How often do conflicts result in either person feeling hurt or misunderstood?
  • Non-Verbal Communication: How attuned are you to your partner’s non-verbal cues (e.g., body language, facial expressions)?
  • Non-Verbal Communication: Do you feel that your partner is responsive to your non-verbal signals (e.g., gestures,mood changes)?

  • Values Alignment

  • Shared Life Goals: How aligned do you and your partner feel about your long-term life goals (e.g., career, family, lifestyle)?
  • Personal Values: How often do you and your partner discuss your personal values and how they shape your decisions?
  • Personal Values: How much do your core personal values overlap with your partner’s values?
  • Daily Living and Shared Decisions: How aligned are you and your partner in daily decision-making (e.g., finances, household responsibilities)?

  • Love Languages

  • Understanding Each Other's Love Language: How well do you understand your partner’s primary love language (e.g., words of affirmation, acts of service, physical touch, quality time, receiving gifts)?
  • Understanding Each Other's Love Language: How often do you consciously express love to your partner in their preferred love language?
  • Feeling Loved: How often do you feel loved and appreciated by your partner in the way you prefer toreceive love?
  • Feeling Loved: How important is it to you that your partner expresses love in your preferred love language?

  • Strength of Relationship

  • Trust and Emotional Security: How much do you trust your partner to be honest and loyal in your relationship?
  • Trust and Emotional Security: How emotionally secure do you feel in your relationship?
  • Support and Partnership: How well does your partner support you during difficult times (emotionally, mentally, or physically)?
  • Support and Partnership: How satisfied are you with the balance of partnership (e.g., shared responsibilities,mutual support) in your relationship?
  • Relationship Strength: How would you rate the overall strength of your relationship?

  • Interpretation of Scores:

    • 90 - 112: Relationship is thriving with strong intimacy, communication, and
      alignment.
    • 70 - 89: Relationship is strong but could benefit from specific areas of growth.
    • 50 - 69: Relationship is stable but requires attention in several key areas.
    • Below 50: Relationship may be struggling and could greatly benefit from
      coaching.

    This scoring system allows for an objective assessment based on the couple's
    responses while leaving room for open-ended exploration and tailored
    recommendations.

    If you are interested in  cultivating more intimacy, love and connection  in your relationship, feel free to reach out to Michael for a discovery call to see if you are a right fit for his couples program
    https://calendly.com/ michaeldostrolenk/30-minute- coaching-with-mo-clone

     

     

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