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Healthy Relationship Checklist Form Template

Enhance communication and connection with your partner

Feeling uncertain about the strength of your relationship? This Healthy Relationship Checklist Form Template is designed for singles and couples looking to assess and improve their relationship dynamics. With this interactive tool, you can identify key areas of strengths and weaknesses, foster open dialogue, and create actionable steps for growth, all while promoting mutual understanding and respect. Customize it to your unique needs and preferences, and start transforming your relationship today.

How long have you been in your current relationship?
Not in a relationship
Under 3 months
3-12 months
1-3 years
3-5 years
5+ years
Prefer not to say
Do you and your partner live together?
Yes
No
Prefer not to say
I feel respected by my partner.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We communicate openly and listen to each other.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Boundaries and consent are discussed and honored.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We make decisions together that feel fair to both of us.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We can disagree without insults or put-downs.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We both maintain friendships and interests outside the relationship.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We resolve conflicts in ways that feel constructive.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I feel emotionally safe sharing my needs and feelings.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
We respect each other's privacy with phones and social media.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I have felt afraid of my partner.
Never
Rarely
Sometimes
Often
Always
Prefer not to say
My partner monitors my location or checks my devices without permission.
Never
Rarely
Sometimes
Often
Always
Prefer not to say
Physical force has been used by me or my partner in this relationship.
Yes
No
Prefer not to say
Which areas would you most like to improve?
Anything else you would like to share?
What kinds of support would be most helpful right now?
Self-guided resources
Couples counseling
Individual counseling
Safety planning information
Support group
Talk with a trusted friend or family member
Legal advice
Not sure yet
Preferred contact method (optional)
Email
Phone call
Text message
No follow-up needed
Email (optional)
Phone (optional)
Today's date
I understand this checklist is informational and not a substitute for emergency services.
Yes
No
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Paper art illustration depicting a checklist with heart symbols and healthy relationship keywords for a template guide.

When to use this form

Use this checklist when you want a clear, honest check-in about how the relationship is working. It helps couples before moving in, after a rough patch, or during premarital counseling. Schedule a quarterly review to spot patterns and set small goals. Early-stage partners can pair it with the Dating questionnaire form to explore values, boundaries, and deal breakers. If you are reviewing a close friendship, the Best friend application form can support expectations for non-romantic bonds. Therapists and coaches can use it as homework between sessions. The outcome: shared understanding, agreed next steps, and early flags you can address together.

Must Ask Healthy Relationship Checklist Questions

  1. Do you feel safe, respected, and heard with your partner?

    Safety and respect are the foundation of any healthy bond. If either is missing, you can prioritize boundaries or support before tackling other topics.

  2. When conflict happens, how do you two cool down and resolve it?

    This reveals whether you attack, avoid, or repair. It helps you agree on a simple process for next time, like a timeout and a calm debrief.

  3. Do you both share clear expectations about time, intimacy, and personal space?

    Mismatched needs create friction and mixed signals. Your answers turn into concrete agreements about check-ins, affection, and alone time.

  4. How transparent are you about money, chores, and decisions that affect both of you?

    Secrets and uneven loads breed conflict. Use this to decide how you will share info, make a basic budget, and rotate tasks fairly.

  5. What is one small, specific action you will each take in the next 30 days?

    Time-bound commitments turn insight into progress. You can also track trends over time with the Relationship satisfaction survey form.

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