Strengthen Your Bond with a Relationship Survey

Help couples understand their communication patterns and relationship satisfaction with this confidential, easy-to-use assessment survey template.

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Couples Communication & Relationship Satisfaction Assessment Survey

Your Full Name

· · ·

Email Address

· · ·

Age Range

Submit

The Couples Communication & Relationship Satisfaction Assessment Survey is a thoughtfully designed tool that helps partners gain deeper insight into their communication styles, emotional well-being, and overall relationship satisfaction. It covers key areas including conflict sources, emotional support, shared responsibilities, and appreciation — giving couples a holistic picture of their relationship health.

This template is ideal for relationship coaches, therapists, counselors, and mental health professionals who want to gather meaningful data from clients before sessions. It's also useful for researchers studying relationship dynamics or organizations running couples workshops and enrichment programs.

By using this ready-made survey template, you can quickly collect confidential, structured responses without building a form from scratch. Customize the questions to fit your practice or program, and use the insights to guide productive conversations, targeted counseling, or evidence-based interventions that help couples thrive.

4 Pages

18 Questions

~6min To complete

Free No credit card needed

Field types Dropdown ×4 Long Text ×3 Single Choice ×2 Likert Scale ×2 Full Name Email Multiple Choice Scale Rating NPS Score ranking termsandconditions

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Personal & Relationship Background 6 questions

Personal & Relationship Background

Welcome! This assessment is designed to help you and your partner better understand your communication patterns and relationship satisfaction. Your responses are confidential and will be treated with care. Please answer as honestly and openly as you feel comfortable.

1 Your Full Name * Full Name

2 Email Address * Email

3 Age Range * Dropdown

4 Relationship Status * Dropdown

5 How long have you been in your current relationship? * Dropdown

6 Do you currently live with your partner? * Single Choice

Page 2 Communication Patterns 2 questions

How You & Your Partner Communicate

1 How often do you and your partner have meaningful conversations? * Dropdown

2 What are the most common sources of conflict in your relationship? * Multiple Choice

Page 3 Relationship Satisfaction & Emotional Connection 6 questions

Satisfaction & Emotional Well-Being

1 Overall, how satisfied are you with your relationship? * Scale Rating

2 How likely are you to recommend couples counseling or communication workshops to other couples? * NPS Score

3 I feel emotionally supported by my partner * Likert Scale

4 I feel that my partner and I share equal responsibility in maintaining the relationship * Likert Scale

5 Rank the following in order of importance to your relationship satisfaction * ranking

6 Have you and your partner ever attended couples therapy or counseling? * Single Choice

Page 4 Reflections & Final Thoughts 4 questions

Your Reflections

1 What is one thing your partner does that makes you feel most loved and appreciated? Long Text

2 What is one area of communication you would most like to improve in your relationship? Long Text

3 Is there anything else you would like to share about your relationship experience? Long Text

4 I understand that my responses are anonymous and will be used solely for research purposes. * termsandconditions

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.