User Generated Form

Healthy Relationship Survey

Are you looking for a way to gain insight into the relationships of your clients? Our Healthy Relationship Survey can help! This valuable tool provides an easy to use survey that will help you assess the quality of your clients' relationships.


Our survey is designed to help you understand the key elements of a healthy relationship. It covers topics such as communication, trust, and conflict resolution. It also provides an opportunity for your clients to reflect on their current relationships and express their thoughts and feelings.


The survey is designed to be comprehensive and easy to use. It consists of a series of multiple-choice questions that are designed to help you better understand the dynamics of your clients' relationships. The questions are designed to be straightforward and easy to answer, so that even those who are uncomfortable discussing their relationships can find the survey easy to complete.


The Healthy Relationship Survey is a great way to assess the quality of your clients' relationships and give you the insight you need to provide the best possible support. It is a valuable tool for any professional who works with couples or individuals in relationships.

Healthy Relationship Survey

  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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