The Relationship Assesment Quiz

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Name
First Name
Last Name
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Where did you find this quiz?
KHTS Radio
Facebook
Other Social Media
Website
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I am/ resonate as...Men and Women experience relationship differently
Female/the FeminineMale/ the Masculine
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Where is your Relationship At Right Now?* This field is required.
Getting Married & I want to make sure we set ourselves up with strong foundations for Success!
We are Great! Happy & Thriving!
Good, but Needs Improvement
A Yo-Yo.. Constantly Up and Down: We need help keeping things good.
Consistently Not so Good, On the Decline, Help!
On the Brink of Divorce, but I have hope we can stil save it from here.
Divorce is Inevitable, and I just don't care to even try to save it anymore.
Already Divorced, but I want to heal my past so that I don't repeat these same patterns in my next relationship.
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List your greatest 3 challenges in this Relationship:List in order
Challenge #1
Challenge #2
Challenge #3
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Can you easily communicate about the things that are important to you? ....are your thoughts heard, understood & well recieved?* This field is required.
Never
Rarely
Sometimes
Often
Always
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Do you feel like you're "walking on eggshells" with your partner?* This field is required.
Never
Rarely
Sometimes
Often
Always
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How often do you get into a Conflict?* This field is required.
1- 4 times a DAY
1- 4 times per WEEK
1- 4 times per MONTH
1- 3 times every other month or so
1- 3 times per YEAR
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When in a conflict, how does it resolve?* This field is required.
It gets really bad, feels like an all out emotional war and sometimes results in physical violence.
It usually doesn’t get resolved.. we end up feeling angry, hurt, more disconnected and often sleeping separately.
50/50 half the time they are resolved peacefully, the other half are painful, left unresolved and create more disconnection between us.
More often than not, we are able to resolve our conflicts and end on good terms, but I still feel we could use some improvement in this area.
We always resolve our conflicts respectfully. My partner is consistently empathetic and understanding of my perspective and we work as a team to find a solution that works for both of us.
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How often are you Sexually Intimate with your Partner?* This field is required.
Not at all for a year or longer
1- 2 times each YEAR
1 time every 2 - 4 Months
1-4 times each MONTH
1- 4 times each WEEK
1- 2 times each DAY
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How would you describe your overall sexual dynamic with your partner?* This field is required.
It's always horrible, I try to avoid it at all costs.
It is a Chore, I try to avoid it most of the time.
It's OK, but moslty we are just going through the motions.
It's Good, but I dont feel wanted, connected or passion from my partner.
It's Connected, Engaged, Hot, Passionate & Fun!
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What is your deepest desire for your relationship?Click NEXT when done.
Huge
Large
Normal
Small
Ok
Ok
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How would you rate your relationship on a friend-lover scale?* This field is required.
We were never "friends" nor "lovers"
We are passionate lovers, but not really friends.
We are like room-mates & good friends, but not lovers.
Lost connection. We used to be best friends and best lovers, but not so much of either anymore.
We are best friends and best lovers!
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How mutual/equal is the exchange of love, empathy, effort and service your relationship?* This field is required.
90/10, my partner does not reciprocate any of the love, empathy, effort or service into the relationship.
10/ 90, my partner gives way more of these things into the relationship than I do.
70/30 I give much more/ and my partner somewhat reciporactes.
60/40 I give more/ and my partner almost reciprocates.
50/50 We each reciproacte the love, empathy, effort and service into the relationship.
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Does your partner support, uplift you and "have your back"?* This field is required.
Never
Rarely
Sometimes
Often
Always
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Do you Trust your Partner?* This field is required.
Not at All.
In some areas, but not with parenting.
In some areas, but not completley when it comes to fidelity.
Absolutley with Everything
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Do you feel responsible for your partner's feelings?* This field is required.
Never
Rarely
Sometimes
Often
Always
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Do you pretend everything is fine when it's not?* This field is required.
Never
Rarely
Sometimes
Often
Always
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Do you find it difficult to express your feelings and needs?* This field is required.Or if you do, does your partner turn it around on you, making you wrong for asking?
Never
Rarely
Sometimes
Often
Always
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Does your partner use their words, shame or criticism in an attempt to discredit your needs or desires?* This field is required.
Never
Rarely
Sometimes
Often
Always
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How well does your Partner meet your Needs?* This field is required.
Never
Rarely
Sometimes
Often
Always
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How often do you feel like you have to beg, plead, nag, demand or use ultimatums?* This field is required.
Never
Rarely
Sometimes
Often
Always
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What is your greatest fear about your relationship?* This field is required.Click NEXT when done.
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Did you have a successful model of love growing up?* This field is required.
Yes! My parents never divorced, and showed love, affection and connection on the daily, towards me AND towards each other.
Somewhat. They mostly fought, but did share a few solid examples of love and connection towards me AND towards each other.
No... there was little or no examples of love between my parents; BUT towards myself, I felt my parent's warmth, support, and loving acceptance overall.
No... there was little or no love between my parents, and I mostly felt unloved (verbal, emotional, or physical) pain towards me.
No. There was ANGER and HATRED between my parents & there was ABUSE (verbal, emotional, or physical) towards me. I did not have a warm, supportive relationship from one OR both of my parents.
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What have you tried so far?* This field is required.Please check all that apply & Click NEXT when done.
We have not yet reached outside of our relationship for help
Workshops & Books or Chuch Groups
Traditional Relationship Counseling/ Therapy
Personal Counseling/ Therapy
A structured Relationship Program with feedback, tools, action steps and personal sessions.
A step by step cognitive approach to re-wire negative relationship patterns.
Deep Healing Sessions (Healing Childhood Trauma)
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Why was the above not effective for you?* This field is required.Type N/A if you have not yet tried anything. Click NEXT when done.
Huge
Large
Normal
Small
Ok
Ok
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Would you take a chance to transform it all?* This field is required.If you could heal all of the negative dynamics and begin to thrive together for the long term, would you take that chance?
YESNO
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How willing are you?* This field is required.If you were given a specialized roadmap guiding you on exactly how to evoke your partner's desire, heal the pain, and create a solid connection that lasts... How willing are you to do the internal work necessary for this kind of outcome?
100% willing & dedicated to do what ever it takes, I am determined to get this right.
75% willing, with a new approach and a proven process that works.
50% Unsure what to do or where to go. I need guidance.
25% I am worn out and would rather settle for an unhappy marriage.
10% Count me out. I do not want to grow from any challenges of life.
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Your Email* This field is required.
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Click SUBMIT to see what this score MEANS...Your Score
This is Your Score. Click SUBMIT to see what your score means.
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