Answer each statement honestly. Keep in mind that we all have strengths and weaknesses; No one is perfect. The point of this exercise is to not point fingers, but rather to help identify where there may be weaknesses in how you and the person you’re with approach being together.

If you have been together for quite some time (like for years), answer the question thinking about more recent history, like over the past few months to year. This way you can start tracking progress if progress is occuring.

This information will be used to help identify core areas of strengths and weakness, as well as to identify where to potentially focus your efforts to strengthen your relationship together.

How to answer each statement:

• Strongly Agree if the statement is absolutely true
• Agree if the statement has not been true just a few times since you’ve been together, and these few times are not a cause of ongoing problems or drama in your relationship
• Neither Agree or Disagree if there are definitely times when the statement is not true, but you don’t think this is a source of problems in your relationship
• Disagree if the statement is definitely untrue at times and you believe this is a source of problems in your relationship
• Strongly Disagree if the statement is typically untrue and you believe this is one of the leading sources of problems in your relationship
• Don’t Know if you honestly have no idea if the statement is true or not.

Your answers are kept confidential to you and will not be shared without your permission.