What is your email?

Relationship Information

What is your current relationship status?

How long have you been together?

Do you and your partner currently live together?

Relationship Assessment

Please answer using a scale of 1 to 10, where:

1 = Not at all / Very negative

10 = Extremely / Very positive

How would you describe the current state of your relationship?

How valued, appreciated, and respected do you feel in your role as a partner?ow would you rate the level of trust in your relationship?

Do you feel safe to share your thoughts, whether dreams or challenges, in the relationship?

Do you have a strong (good) friendship with your partner?

How well do you make decisions together?

Relationship Assessment

Do you believe you have a trusting relationship?

Do you experience more positive or negative interactions in your relationship?

Do you get stuck in your conflicts or are you able to work through them to a WIN/WIN solution?

How much unresolved pain or baggage from the past do you feel is still affecting your current relationship?

Do you have a vision for your relationship and where you are heading?

Would you be interested in scheduling a free consultation call to discuss your personalized recommendations with an XO Certified Relationship Coach ?

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Last Name

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