How happy am I in the relationship at the moment?
Extremely unhappy
Extremely happy
How often have we had quality time together (not in front of screens/tv) this week?
None at all
check
Once or twice
Several times
Every day
How willing am I to do something with my partner that I wouldn’t normally choose to do?
Totally unwilling
Always willing
How many times have we been sexually intimate in the last 2 weeks?
Once
Twice
3–4 times
5+ times
Prefer not to say
None - choosing no sex before marriage
How happy am I with our physical intimacy?
I talk about what needs to be done
I talk about facts and things I know
I share what I think and my opinions
I express a wide range of feelings in a sensitive and considerate way
I talk vulnerably and openly about almost everything
How happy am I with the openness in our communication?
I try to do kind things for my partner…
Not sure that I do
Once or twice a week
Once or twice a day
Several times a day
How happy am I about the way we handle money as a couple?
When my partner tries to talk to me about a tricky issue, my response is to …
Always refuse to talk about it
Usually refuse to talk about it
Usually be willing to talk about it
Always willing to talk about it
Overall, how much do I trust my partner?
I don't trust my partner
I totally trust my partner
How committed am I to making our relationship work for the rest of our lives?
Not at all committed
100% totally committed
Work/Job Stress
Physical/Mental Issue
Money worries
A new baby
Children / teenagers
Infertility
Previous relationships
Moving house / home issues
Tension of different religious beliefs
Other stresses and strains
Not dealing with any pressures right now
