Discover US
Do we have a healthy, secure and connected relationship?
Name
*
First Name
Last Name
Email
*
example@example.com
City/Town - State/Province
*
Where Do You Live?
1 - Emotional Connection/Support
How "connected" do I feel?
1. I feel emotionally safe. I feel comfortable expressing my TRUE thoughts and feelings
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False - I don't feel safe. It never goes well.
0
1
2
3
4
True - I feel very safe. I feel accepted!
5
0 is False - I don't feel safe. It never goes well. , 5 is True - I feel very safe. I feel accepted!
2. My partner is a good listener and shows genuine interest in our relationship
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False - They seem distant and disconnected.
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True - My partner is "all in".
5
0 is False - They seem distant and disconnected. , 5 is True - My partner is "all in".
3. My partner supports my growth, goals and dreams without jealousy. They encourage my passions and interests.
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False - They are not supportive at all.
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True - They are very supportive.
5
0 is False - They are not supportive at all. , 5 is True - They are very supportive.
4. I feel respected, valued and appreciated in the relationship.
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False - I don't get much respect.
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1
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True - I feel very appreciated and valued.
5
0 is False - I don't get much respect. , 5 is True - I feel very appreciated and valued.
Emotional Connection/Support Total
2 - Trust & Reliability
Can I be me?
5. I can trust my partner to be honest, faithful and reliable.
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False - No, I don't really trust them.
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True - Yes, they are extremely trustworthy.
5
0 is False - No, I don't really trust them. , 5 is True - Yes, they are extremely trustworthy.
6. My partner follows through with their commitments and promises.
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False - They rarely if ever follow through.
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True - They consistently keep their word and do what they say they will do.
5
0 is False - They rarely if ever follow through. , 5 is True - They consistently keep their word and do what they say they will do.
7. I feel comfortable to share my vulnerabilities without fear of judgment or rejection
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False - I can't share at all. I will be judged every time.
0
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True - I feel comfortable to share whatever I need to share.
5
0 is False - I can't share at all. I will be judged every time. , 5 is True - I feel comfortable to share whatever I need to share.
8. I can relax and be my authentic self in the relationship. I don't walk on eggshells.
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False - I hide who i really am. I juts want to keep the peace.
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2
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True - I am my true and authentic self!
5
0 is False - I hide who i really am. I juts want to keep the peace. , 5 is True - I am my true and authentic self!
Trust & Reliability Total
3 - Compatibility & Communication
Are we compatible?
9. We share similar Core Values, beliefs and long-term visions for life
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False - We are very different people.
0
1
2
3
4
True - Yes, we agree on almost everything!
5
0 is False - We are very different people., 5 is True - Yes, we agree on almost everything!
10. We have healthy and open communication. We are comfortable having hard discussions.
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False - We have trouble communicating
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True - We can talk easily about anything.
5
0 is False - We have trouble communicating, 5 is True - We can talk easily about anything.
11. We have fun together and enjoy each others company
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False - We don't have a lot of fun.
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2
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True - We have fun no matter what we are doing.
5
0 is False - We don't have a lot of fun. , 5 is True - We have fun no matter what we are doing.
12. We contribute equally to the relationship both emotionally and practically.
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False - It doesn't feel all that equal.
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True - Yes, we both contribute equally.
5
0 is False - It doesn't feel all that equal., 5 is True - Yes, we both contribute equally.
Compatibility & Communication Total
4 - Emotional & Physical Intimacy
Signs of true intimacy.
13. I feel emotionally connected to to my partner, not just physically.
*
False - I am not connected at all.
0
1
2
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True - I feel very connected!
5
0 is False - I am not connected at all. , 5 is True - I feel very connected!
14. Our overall intimacy is fulfilling and mutual. (physical, emotional and intellectual)
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False - I am not fulfilled at all.
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True - I feel very fulfilled!
5
0 is False - I am not fulfilled at all. , 5 is True - I feel very fulfilled!
15. I feel safe expressing my needs and my partner normally meets my needs.
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False - My needs are not a factor in this relationship.
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True - I feel my needs are usually met.
5
0 is False - My needs are not a factor in this relationship., 5 is True - I feel my needs are usually met.
16. I am genuinely happy and at peace in this relationship, most of the time.
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False - I feel overwhelmed and anxious most of the time.
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True - I am at peace most of the time.
5
0 is False - I feel overwhelmed and anxious most of the time. , 5 is True - I am at peace most of the time.
Emotional & Physical Intimacy Total
5 - Conflict / Disruptions
Text
17. We work through conflict with understanding and kindness rather than blame or avoidance.
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False - We have problems dealing with conflict fairly.
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True - We deal with conflict fairly and effectively.
5
0 is False - We have problems dealing with conflict fairly. , 5 is True - We deal with conflict fairly and effectively.
18. We are both good at taking responsibility for our actions instead of making excuses and shifting blame.
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False - There is a lot of defensiveness and excuses.
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True - We both are good at accepting responsibility.
5
0 is False - There is a lot of defensiveness and excuses. , 5 is True - We both are good at accepting responsibility.
19. We respect each others differences without trying to control or change one another.
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False - We consistently point out flaws and issues with each other.
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True - We both feel accepted for who we are.
5
0 is False - We consistently point out flaws and issues with each other. , 5 is True - We both feel accepted for who we are.
20. If nothing ever changes, I would still want to be in this relationship in 5 years.
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False - I feel that that changes are needed.
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True - I am content with things just as they are.
5
0 is False - I feel that that changes are needed. , 5 is True - I am content with things just as they are.
Conflict / Disruptions Total
My Quick Discover US Assessment Total
Would You Like Feedback on Your assessment?
Check one of the boxes below and push the Submit button!
I agree to receive feedback on what the number mean and would like to learn more learning more about how ACP / DiscoverUS can help us to explore healthy relationship skills and improve our relationship
*
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Maybe (We will send you an email to start a dialogue to see what might be possible.)
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Yes, We would like to participate in the Free Couples Counseling Program! (Beta)
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