Renew Relationship Counseling

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

Renew Relationship Counseling

Sign in to Google to save your progress. Learn more

Mini Relational Assessment

When couples begin to struggle in their relationship, the struggle typically begins to present itself in one or more of the following areas. While these areas are rarely the root cause of the problems, they are often the place in which the problem is manifest. To begin exploring the health of your relationship, please rate your relationship in the following areas:

Management of Finances

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Satisfaction with Intimacy

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Healthy Communication

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Shared Values

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Loyalty & Commitment

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Compatible Goals/Aspirations

1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Very Good

1

2

3

4

5

Clear selection

Assessment Score

Find your Score by adding together each of your ratings above. Write down your Score so that you don't forget it!

Your Name

Your Email Address

Your Phone Number

Type your Score into the box below. Then hit submit to INSTANTLY receive your results! *

REMEMBER YOUR SCORE!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Renew Relationship Counseling.

Does this form look suspicious? Report