0%
0:0
surveyanalytica logo

Couples Survey

To determine if you and your partner is in a healthy relationship
Page 1

1

*

Who is filling out this form?

2

*

Your Age

3

*

Your partner's age

4

*

Your Annual Income

5

*

Your Partner's Annual Income

6

*

Your Highest Level of Education

7

*

Partner's Highest Level of Education

8

*

What is your relationship status?

9

*

How many years have you been together?

10

*

How satisfied are you with your partners emotional support?

11

*

How satisfied you are with the respect and admiration received from your partner?

12

*

How satisfied are you with your partners financial support?

13

*

How satisfied are you with your sex life?

14

*

How satisfied are you with the time you spend together with your partner?

15

*

How often do you argue about the following reasons?
Daily
Weekly
Monthly
Rarely
Never
Money
Friends
Parents
Household Chores
Children / Pets
Phone Usage
Responsibilities
Time Spent Together
Intimacy
Each Others Appearance

16

*

How fast are your relationship issues resolved or forgiven?

17

*

From 1 to 10 how would you rate your relationship?

brand
|