Please complete the following survey separately. This information is used to assist me in customizing the couples retreat, in an effort to help you reach your goals.

Required Information

Characters Remaining: 100
Characters Remaining: 100

Relationship Information

RELATIONSHIP STATUS
Rate the following positive relationship characteristics based on HOW YOU FEEL at this point in your relationship. Check "Excellent" for relationship strengths;  "Adequate," if there is room for improvement; and "Poor," if you struggle and could use new skills, strategies, and insights.
Spiritual Compatibility
Spiritual Compatibility
Shared Values & Ethics
Shared Values & Ethics
Shared Dreams & Goals
Shared Dreams & Goals
Shared World View
Shared World View
Allowing and Accepting of Differences
Allowing and Accepting of Differences
Comfort with Gender Roles
Comfort with Gender Roles
Sexual Chemistry and Attraction
Sexual Chemistry and Attraction
Shared Financial Values
Shared Financial Values
Boundaries: Friends
Boundaries: Friends
Boundaries: Activities - Work, Phone, Hobbies...
Boundaries: Activities - Work, Phone, Hobbies...
Boundaries: Extended Family
Boundaries: Extended Family
Boundaries: Ex Partners
Boundaries: Ex Partners
Communication Skills
Communication Skills
Equity & Division of Labor
Equity & Division of Labor
Resolving Disagreements
Resolving Disagreements
Repairing & Forgiving Hurts & Resentments
Repairing & Forgiving Hurts & Resentments
Managing Sensitivity and Defensiveness
Managing Sensitivity and Defensiveness
Avoiding Criticism and Condescension
Avoiding Criticism and Condescension
Compatible Sexual Interests
Compatible Sexual Interests
Healthy Non/Use of Addictive Substances
Healthy Non/Use of Addictive Substances
Comfort with Same-Sex Relationship
Comfort with Same-Sex Relationship
Peace with Past Traumas
Peace with Past Traumas
Co-Parenting Skills (skip if not applicable)
Co-Parenting Skills
Physical Violence-Free Conflicts
Physical Violence-Free Conflicts
Feel Known, Seen and Understood
Feel Known, Seen and Understood
Feel I Am Enough As I Am
Feel I Am Enough As I Am
Feel Respected, Admired and Loved
Feel Respected, Admired and Loved
Feel Desired
Feel Desired
Shared Laughter and Fun
Shared Laughter and Fun
Mutual Trusting
Mutual Trusting
Secure with Commitment
Secure with Commitment
Sense of Freedom and Independence
Sense of Freedom and Independence
Enjoyable Social Experiences and Friendships
Enjoyable Social Experiences and Friendships
Enjoyable Day-to-Day Life
Enjoyable Day-to-Day Life
Experience Empathy, Caring and Support
Experience Empathy, Caring and Support
Experience Kindness and Generosity
Experience Kindness and Generosity
Sexually Satisfied
Sexually Satisfied
Overall Relationship Satisfaction
Overall Relationship Satisfaction
Rank the following in order of importance to address in your relationship - #1 is "TOP CONCERN" AND #8 is "LOWEST CONCERN" - It may be helpful to first identify your biggest concern, then your lowest concern, and fill the rest in accordingly.
Characters Remaining: 350
Characters Remaining: 1000