1. Personal Information
- Name (Partner 1): Emily Johnson
- Name (Partner 2): Michael Smith
- Age (Partner 1): 28
- Age (Partner 2): 30
- Relationship Duration: 5 years
- Marital Status:
- A) Married
2. Relationship Satisfaction (MCQs)
Q1: How satisfied are you with your current relationship overall?
- B) Satisfied
Q2: How often do you and your partner spend quality time together?
- B) Several times a week
Q3: How often do you and your partner argue?
- C) Sometimes
3. Communication and Understanding (Likert Scale)
Q4: Please rate your agreement with the following statements:
- We communicate openly and honestly with each other.
- Agree
- I feel understood and supported by my partner.
- Strongly agree
- We can resolve conflicts in a healthy manner.
- Neutral
4. Mutual Goals and Future Planning
Q5: How often do you and your partner discuss long-term plans and goals (e.g., finances, children, career)?
- B) Occasionally
Q6: Do you and your partner share similar values regarding important life decisions (e.g., finances, family, lifestyle)?
- B) Mostly
5. Open-Ended Questions
Q7: What do you appreciate most about your partner and your relationship?
- I appreciate how supportive and understanding Michael is. He’s always there when I need him, and we work well together as a team.
Q8: What areas of your relationship do you feel could be improved?
- I think we could work on improving our conflict resolution skills. Sometimes, we leave issues unresolved, which can cause tension later on.
6. Ranking Questions
Q9: Rank the following aspects in terms of importance to your relationship (1 = most important, 4 = least important):
- 1) Communication
- 2) Trust
- 3) Shared goals
- 4) Physical intimacy
7. General Relationship Satisfaction
Q10: On a scale of 1 to 10, how satisfied are you with your relationship?
- 8/10
8. Closing Remarks
Thank you for sharing your thoughts. Your feedback will help deepen understanding and improve the quality of your relationship.