Relationship Coaching Survey #1

If you are currently in an intimate relationship, this is the survey for you to complete. If you are not in an intimate relationship at this time, please complete Relationship Coaching Survey #2.

Please respond to the following statements by checking 1, 2, 3, 4, or 5 .

The scale is:

1 -Strongly Agree, 2 -Agree, 3 -Neutral, 4 -Disagree, 5 -Strongly Disagree

You may choose to submit your score at the bottom of this page.

In my intimate relationship, we show affection in sexual and non-sexual ways.

1	2	3	4	5

We can be playful and have fun together.

1	2	3	4	5

We can be angry without trying to hurt each other.

1	2	3	4	5

We speak to each other in ways that build each other up rather than tear each other down.

1	2	3	4	5

We make clear agreements and follow through on them.

1	2	3	4	5

We resolve conflicts in a way that satisfies both of us and allows us to truly forgive each other if we've been hurt.

1	2	3	4	5

The sexual expression of our love is satisfying to both of us.

1	2	3	4	5

There is a deep level of trust between us.

1	2	3	4	5

We have a good balance between the time and activities we share with each other and the time and activities spent alone or with people outside our relationship.

1	2	3	4	5

10.

Our relationship with each other's families is positive.

1	2	3	4	5

TOTAL SCORE:

1 - 25 Wow! Sounds like a great relationship.
26 - 35 Your relationship could be improved by making some changes in a few areas.
36 - 50 You may be experiencing great dissatisfaction in your relationship. Let's explore
how things could be improved.

Name:
Phone:
Email:

Relationship coaching can help individuals or couples to develop better communication and conflict resolution skills, to improve the intimate aspects of their lives, to have a greater sense of play in their relationship, and to renew a deep sense of love. Please click on "Relationship Coaching" in the menu to read a description of the coaching options that might be of value to you. Check out "Personal Coaching" and "Career Coaching" as well.