How's Your Relationship?

Relationship Check-in

A survey of relationship strengths, concerns and needs.

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* 1. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, alone

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* 2. What grade would you give your relationship?

A+ - excellent

A - very good

A- - pretty good

B - okay

C - average

D - poor

F- we're in trouble

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* 3. How long have you been in your current relationship?

< 5 years

5-10 years

10-15 years

> 15 years

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* 4. Which is your most problematic issue?

Communication

Respect

Intimacy

Infidelity

Cold Shoulder

Defensiveness

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* 5. Who is the problem?

They are the problem.

I am the problem.

We both are the problem.

There is an intruder.

There are intruders.

There is an addiction.

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* 6. Have the two of you been to counseling?

Yes, a therapist.

Yes, a pastor.

Yes, an elder.

No, I want to.

No, we don't need it.

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* 7. What are you most likely to do to help your relationship?

Read a book.

Talk to a friend.

Bring the problem to your partner?

Hope it goes away.

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* 8. What is the one thing you would most want to change about your partner, to better your relationship?

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* 9. What is the one thing you would most want to change about yourself, to better your relationship?

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* 10. (OPTIONAL) I'd like to give you a gift for filling out the survey. If you want to receive a $50 gift certificate for "Relationship Repair Kit" (an online course for struggling couples). Please provide your email address below. Thank you!