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
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
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