About this template
The Healthy Relationship Checklist Google Form template is designed to help individuals, partners, and relationship professionals evaluate the core dynamics of a romantic partnership. Whether used independently by couples looking to strengthen their bond or integrated into professional therapy and coaching sessions, this checklist provides a structured way to assess trust, communication, conflict resolution, and emotional support.
Built for easy distribution via a simple link or website embed, this template collects honest insights into relationship strengths and areas for growth. Using Doc2Form, you can instantly convert or customize this template to fit your specific framework, adding targeted rating scales or open-ended reflection prompts.
Gathering this feedback helps facilitate deeper conversations, pinpoints underlying friction points, and encourages proactive relationship maintenance. Responses are securely organized in your connected Google Sheets spreadsheet, making it seamless to track progress over time or prepare for counseling sessions.
Key features
- Assess core dynamics like trust, communication, and mutual respect
- Quickly deploy via a direct link or embed on your website
- Organize all partner feedback neatly in Google Sheets
- Easily add or edit questions to match your specific counseling approach
Use cases
- Pre-marital counseling intake and relationship assessment
- Couples checking in on their relationship health independently
- Relationship workshops and retreat reflection exercises
- Therapeutic check-ins for licensed marriage and family therapists
What this form collects
- Date of Assessment (Date)Enter today's date.
- Your Age (Short answer)Enter your current age.
- Gender Identity (Dropdown)Select how you identify.
- Relationship Duration (Dropdown)How long have you and your partner been together?
- We communicate openly and honestly with each other. (Linear scale)Rate how well you feel you share thoughts and feelings without fear of judgment.
- We trust each other completely. (Linear scale)Consider feelings of reliability, honesty, and emotional safety.
- We resolve conflicts respectfully and constructively. (Linear scale)Think about how disagreements are handled and whether compromises are reached.
- We support each other's personal goals and growth. (Linear scale)Reflect on how well you cheer each other on in life and career.
- We share a similar vision for our future. (Linear scale)Consider alignment on major life values, milestones, and aspirations.
- What do you consider the greatest strength of your relationship? (Paragraph)Briefly describe what makes your partnership thrive.
- What is one area you would most like to improve? (Paragraph)Describe any recurring challenges or topics you would like to address.
FAQ
What is a Healthy Relationship Checklist used for?
It is a survey tool designed to help singles or couples gauge the quality, strengths, and potential areas for improvement in a romantic relationship.
Who can use this relationship assessment template?
It is ideal for marriage and family therapists, counselors, relationship coaches, or couples wanting to foster open communication and self-reflection.
Can I customize the questions in this Google Form template?
Yes. Once generated in your Google Drive, you have full control to add, remove, or edit any questions, rating scales, or sections.
How are responses kept private?
All submissions go directly into your private Google Form results and connected spreadsheet, ensuring complete confidentiality between you and your partner or client.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.