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Healthy Relationship Assessment Form

Maintaining healthy relationships is essential for personal growth and success. By having a better understanding of yourself and those around you, you can develop healthier relationships that will last. To help you and your clients understand the dynamics of their relationships, this Healthy Relationship Assessment Form is designed to provide a comprehensive evaluation of their relationships.

This form assesses the quality of relationships by examining the presence of certain key elements. It also explores the partner's level of communication, ability to resolve conflicts, and emotional support. The questions also cover topics such as trust, respect, and intimacy.

The Healthy Relationship Assessment Form will provide you and your clients with a clear understanding of the strengths and weaknesses of their relationships. With this in-depth assessment, you can identify any areas that need improvement and take steps to create a healthier, more fulfilling relationship. With the help of this form, your clients can build stronger relationships and make better decisions about the people in their life.

Healthy Relationship Assessment Form

  1. Email:
  2. Name: 
  3. What is your current relationship status?
  4. Are you happy with your love life as it is?
  5. If not, what would you want it to be?
  6. What stands in the way?
  7. What are some things you have tried?
  8. On a scale of 0-10 how serious are you about having what you want?
  9. Are you serious enough to invest both emotionally and financially towards your own healing and results?  
  10. What do you foresee happening if you do nothing?
  11. Have you ever participated in a personal growth workshop or intensive, either online or offline? If so, please indicate what kind.
  12. Have you ever done a personal growth retreat? If so, please indicate what kind.
  13. Which would you prefer?
  14. How much do you normally invest in personal growth or results oriented coaching?
  15. By taking this survey you have been a big support. Would you would like to be added to my preferred list so that you'll be updated when the program is complete and receive your gifts and special promo code.
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