Relationship Health Test Form

Relationship Health Test Form

This form is to help determine the health of your romantic relationship and how much quality time you and your significant other share.
How much time do you share with your significant other?

Other
If it is not enough time, what is keeping you apart?

Other
What can be done to improve this situation?

Other
What interests do you and your partner share?

Other
Are your needs getting met?

Other
If not, what would you like, want or need more of?
Are your partner's needs getting met?

Other
If not, what do they like, want or need more of?
How do you handle conflict in the relationship?

Other
How does your partner handle conflict in the relationship?

Other
How much do you enjoy your relationship?

Other
How much does your partner accept you?

Other
Seriously, how committed are you to improving your relationship?
Is there anything that you would like help talking to your partner about?
What would you like to say about this test?
Who are you willing to speak with? (if other, please add their name and email address)

Other
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 member of Mixed Recovery.
Signature
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