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17
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1
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"There are no right or wrong answers"
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2
How would you describe your current communication?
We barely talk deeply anymore
Conversation often turn into conflict
We avoid difficult topics
We communicate fairly well most of the time
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3
When conflict happens, what usually occurs?
Someone emotionally shuts down
We argue repeatedly about similar things
We avoid discussing it altogether
We work through it respectfully
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4
How emotionally safe does the relatinship feel?
Not very safe
Safe sometimes, tense other times
I'm careful about what I say
Mostly safe and supportive
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5
How connected do you feel emotionally?
Very disconnected
Connected, but often hurt
Unsure or inconsistent
Deeply connected overall
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6
What best describes your trust level?
Trust feels broken or damaged
Trust changes depending on conflict
Trust exists, but vulnerability is hard
Trust is generally strong
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7
What happens after disagreements?
Distance increases
The same issue returns repeatedly
We pretend everything is fine
We usually repair and reconnect
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8
How are boundaries handled?
Boundaries are unclear or ignored
Boundaries create arguments
We avoid setting boundaries
Boundaries are respected
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9
How hopeful do you feel about the relationship?
I feel discouraged
I want things to be better, but feel stuck
I don't know
I feel hopeful and committed
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10
Which statement feels most true?
We feel emotionally distant
We love each other but clash often
We avoid honesty to keep peace
We're growing together intentionally
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11
What do you most desire for the relationship?
Reconnection
Peace and understanding
Emotional safety
Continued growth and understanding
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12
Calculation
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13
Name
First Name
Last Name
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14
Email
example@example.com
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15
Which best describes you?
Mother
Daughter
Type option 3
Type option 4
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16
What age group best describes the daughter?
Teen (13-17)
Young Adult (18-25)
Adult (26+)
Type option 4
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17
Please verify that you are human
*
This field is required.
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18
What is your biggest relationship challenge right now?
Communication struggles
Constant conflict
Emotional distance
Trust issues
Setting healthy boundaries
Healing past hurts
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