About this template
A relationship survey is an essential questionnaire used by marriage counselors, family therapists, and psychologists to gather structured feedback from couples. This comprehensive assessment tool helps practitioners evaluate core relationship dimensions such as communication quality, emotional intimacy, trust, conflict resolution styles, and shared life goals. By collecting these insights before or during counseling sessions, professionals can quickly identify underlying friction points and tailor their therapeutic approach to the couple's unique needs.
Designed for ease of use, this template streamlines intake and progress tracking for therapy practices. Instead of relying on ad-hoc discussions, practitioners can deploy this structured survey digitally, allowing partners to reflect independently and share honest perspectives. With Doc2Form, you can instantly turn this document into a ready-to-use Google Form, customize questions to fit your specific therapeutic framework, and securely collect responses in one organized place.
Key features
- Assess communication, trust, and intimacy in a structured format.
- Identify recurring conflict triggers and resolution styles.
- Evaluate shared goals, values, and mutual support levels.
- Track relationship satisfaction metrics over the course of therapy.
- Fully customizable to match your specific counseling intake process.
Use cases
- Initial intake assessments for new couples counseling clients.
- Periodic progress check-ins during multi-week therapy programs.
- Pre-marital counseling compatibility and expectation evaluations.
- Academic or clinical research into interpersonal relationship dynamics.
What this form collects
- Relationship Duration (Short answer)How long have you and your partner been together (dating, engaged, or married)?
- Communication Quality Rating (Linear scale)Rate the overall quality of communication between you and your partner on a scale from 1 to 5.
- Communication Methods (Checkboxes)Select the primary ways you and your partner typically communicate.
- Communication Challenges (Paragraph)Describe any recurring difficulties or roadblocks you face when trying to talk through important issues.
- Quality Time Frequency (Dropdown)How often do you and your partner spend meaningful, uninterrupted time together?
- Quality Time Satisfaction Status (Multiple choice)Are you satisfied with the amount and quality of time you spend together?
- Intimacy Level Rating (Linear scale)Rate your level of satisfaction with emotional and physical intimacy in your relationship.
- Intimacy Improvement Notes (Paragraph)What changes or improvements would you like to see regarding intimacy?
- Conflict Resolution Approach (Multiple choice)How do you and your partner typically handle arguments or disagreements?
- Recurring Conflict Issues (Paragraph)List any topics or subjects that frequently lead to arguments between you and your partner.
- Trust & Honesty Status (Multiple choice)Do you feel completely secure, trusted, and honest within your relationship?
- Trust Concerns (Paragraph)If you have any specific trust or honesty concerns, please describe them here.
- Shared Goals & Values Status (Linear scale)How aligned do you feel with your partner regarding life goals, core values, and future vision?
- Life Goals/Differences Notes (Paragraph)Mention any major differences in life goals, career plans, or core values that concern you.
- Partner Support & Appreciation (Multiple choice)Do you feel adequately supported and appreciated by your partner in your daily life?
- Relationship Satisfaction Rating (Linear scale)Overall, how satisfied are you with your relationship right now?
- Satisfaction Drivers & Improvements (Paragraph)What are the biggest strengths of your relationship, and what one change would most improve your satisfaction?
- Additional Relationship Comments (Paragraph)Please share anything else you would like your counselor or therapist to know.
FAQ
Why use a relationship survey template in therapy?
It provides a structured framework for couples to reflect on their relationship dynamics, express difficult feelings safely, and highlight specific areas that require attention during counseling.
What core topics should a relationship survey cover?
An effective survey covers communication habits, frequency of quality time, emotional and physical intimacy, trust levels, recurring conflict topics, and overall relationship satisfaction.
When should this survey be administered to clients?
It is most commonly used during the initial intake phase of couples counseling to establish a baseline, or periodically throughout therapy to measure progress and shifts in relationship health.
Who can use this relationship survey template?
Marriage and family therapists, licensed counselors, psychologists, social workers, and researchers studying interpersonal dynamics can all utilize this template.
How do I customize and share this form with clients?
With Doc2Form, you can instantly convert this template into a Google Form, modify questions to suit your practice, and share a secure link directly with your clients.
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.