CRC - Relationship Satisfaction Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This voluntary survey allows you to assess progress during therapy. At a minimum, it is suggested that you take this at the beginning and end of therapy. You are welcome to take it during therapy as well as one gauge of progress.

Your initials. John Doe would be J.D. *

Your partner's initials.

When are you taking the survey? *

Beginning of therapy

During therapy

End of therapy

Required

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel emotionally close to my partner.

I think my partner cares about me.

I feel confident we can deal with whatever problems might come up in our relationship.

I consider myself happy in this relationship.

My partner usually listens to me.

Our home life together feels chaotic.

Our arguments seem to come up out of nowhere.

I often seem to get blamed for issues.

I look forward to reunions with my partner at the end of each day.

I am satisfied with our sex life (or our decision not to have sex).