Relationship Checkup Assessment

Each partner should complete this assessment separately, then come together to discuss your answers. For each statement, rate how strongly you agree or disagree using the scale below:

  • 5 – Strongly Agree
  • 4 – Agree
  • 3 – Neutral
  • 2 – Disagree
  • 1 – Strongly Disagree

1. Communication


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 1 Score: 0

2. Trust and Honesty


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 2 Score: 0

3. Emotional Intimacy


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 3 Score: 0

4. Physical Intimacy


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 4 Score: 0

5. Shared Goals and Values


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 5 Score: 0

6. Conflict Resolution


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 6 Score: 0

7. Financial Harmony


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 7 Score: 0

8. Quality Time


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 8 Score: 0

9. Independence and Personal Growth


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 9 Score: 0

10. Appreciation and Gratitude


5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1
Section 10 Score: 0