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Relationship Satisfaction Survey Form Template

Gauge relationship dynamics and enhance partner communication

Are misunderstandings causing tension in your relationship? This Relationship Satisfaction Survey Form Template helps therapists and relationship consultants assess their clients' feelings and expectations. By using this template, you can identify areas for improvement, facilitate open communication, and foster deeper connections, all while streamlining your evaluation process. Plus, you can customize it easily, no coding required. Explore the potential for stronger relationships with this practical tool.

What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
What is your current relationship status?
Dating
In a committed relationship
Engaged
Married
Open relationship
Separated
Divorced
Prefer not to say
How long have you been together?
Less than 6 months
6-11 months
1-2 years
3-5 years
6-10 years
11+ years
Prefer not to say
Do you and your partner currently live together?
Yes
No
Overall, how satisfied are you with your relationship?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How often do you feel appreciated by your partner?
Never
Rarely
Sometimes
Often
Always
How easy is it to talk openly with your partner?
Very difficult
Difficult
Neutral
Easy
Very easy
When disagreements happen, I feel they are resolved fairly.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
How satisfied are you with emotional intimacy in your relationship?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How satisfied are you with physical intimacy in your relationship?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
I can rely on my partner.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I feel secure about our commitment to each other.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
How satisfied are you with the quality time you spend together?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How fairly are household responsibilities shared between you and your partner?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
I feel supported by my partner when I am stressed.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
How likely do you see yourselves together in two years?
Very unlikely
Unlikely
Neutral
Likely
Very likely
What is the one thing that would most improve your relationship? (Optional)
Which areas would you most like to improve in your relationship? (Select all that apply)
Please Specify:
Email (optional) if you would like a copy of your responses or relationship resources
May we use your anonymized responses for research and to improve our services?
Yes
No
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Paper art illustration depicting a relationship satisfaction survey form with various checkboxes and questions.

When to use this form

This form helps you check in on your relationship at key moments: before moving in together, after a major conflict, ahead of counseling, or as a monthly pulse. Use it if you are long-distance, blending families, or planning next steps. You get a clear snapshot of strengths, gaps, and priorities, so you can agree on actions and track progress over time. Early in dating, pair results with the Dating questionnaire form to see how values and habits line up. Engaged or married couples can compare with the Marriage survey form for a deeper view of commitment, roles, and goals.

Must Ask Relationship Satisfaction Survey Questions

  1. On a scale of 1 to 10, how satisfied are you with our relationship overall?

    A single rating creates a clean baseline and makes trends easy to spot. It also helps you compare perceptions between partners and measure progress after changes.

  2. How heard and understood do you feel during our conversations?

    This pinpoints whether conflict stems from poor communication or unmet needs. It guides choices like scheduling check-ins or setting ground rules for harder talks.

  3. How fair is the balance of time, chores, and emotional labor between us?

    Uneven workload is a common source of stress and resentment. If you are still defining roles, compare answers with the Boyfriend application form to align expectations early.

  4. How much do you trust me to be honest and faithful?

    Trust drives security, openness, and intimacy. Low scores tell you to prioritize transparency steps, boundaries, or counseling before other goals.

  5. What one change from each of us would most improve our relationship in the next 30 days?

    Specific, time-bound requests turn insights into action. You leave with a short plan you both can commit to and review next month.

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