RELATIONSHIP CHECK-IN

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* 1. What is your age?

18-24

25-29

30s

40s

50s

60s

70+

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* 2. Please indicate your gender

Male

Female

Prefer Not to Answer

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

Married

Engaged

Seriously Dating

Living Together (not married)

The next series of questions is intended for married couples or couples in a committed relationship. Rate how you currently feel about your relationship in the following categories:

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* 4. Closeness / Connection

7 - Excellent

4 - Okay

1 - Struggling

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* 5. Spiritual Beliefs / Faith

7 - Excellent

4 - Okay

1 - Struggling

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* 6. Communication

7 - Excellent

4 - Okay

1 - Struggling

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* 7. Finances / Money

7 - Excellent

4 - Okay

1 - Struggling

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* 8. Roles & Expectations

7 - Excellent

4 - Okay

1 - Struggling

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* 9. Conflict Resolution

7 - Excellent

4 - Okay

1 - Struggling

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* 10. Commitment

7 - Excellent

4 - Okay

1 - Struggling

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* 11. Intimacy & Affection

7 - Excellent

4 - Okay

1 - Struggling

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* 12. Time Together

7 - Excellent

4 - Okay

1 - Struggling

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* 13. Expressing Appreciation

7 - Excellent

4 - Okay

1 - Struggling

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* 14. Forgiveness

7 - Excellent

4 - Okay

1 - Struggling

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* 15. All in all, how satisfied are you with your relationship? Are you . . .

Completely Satisfied

Very Satisfied

Somewhat Satisfied

Not Very Satisfied

Not at all Satisfied

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* 16. In what year were you born?

1999 - 2004

1984 - 1998

1965 - 1983

1946 - 1964

1925 - 1945