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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.
Poor
Adequate
Excellent
Spiritual Compatibility
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Shared Values & Ethics
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Shared Dreams & Goals
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Shared World View
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Allowing and Accepting of Differences
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Comfort with Gender Roles
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Sexual Chemistry and Attraction
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Shared Financial Values
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Boundaries: Friends
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Boundaries: Activities - Work, Phone, Hobbies...
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Boundaries: Extended Family
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Boundaries: Ex Partners
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Communication Skills
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Equity & Division of Labor
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Resolving Disagreements
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Repairing & Forgiving Hurts & Resentments
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Managing Sensitivity and Defensiveness
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Avoiding Criticism and Condescension
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Compatible Sexual Interests
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Healthy Non/Use of Addictive Substances
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Comfort with Same-Sex Relationship
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Peace with Past Traumas
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Co-Parenting Skills
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Physical Violence-Free Conflicts
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Feel Known, Seen and Understood
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Feel I Am Enough As I Am
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Feel Respected, Admired and Loved
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Feel Desired
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Shared Laughter and Fun
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Mutual Trusting
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Secure with Commitment
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Sense of Freedom and Independence
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Enjoyable Social Experiences and Friendships
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Enjoyable Day-to-Day Life
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Experience Empathy, Caring and Support
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Experience Kindness and Generosity
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Sexually Satisfied
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Overall Relationship Satisfaction
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Not at All
Somewhat
Extremely
Rank the following in order of importance to address in your relationship - #1 is "TOP CONCERN" AND #8 is "LOWEST CONCERN"
Emotional Connection / Feeling Understood
Repairing Hurts / Forgiveness
Managing Disagreements / Allowing Differences
Sexual Relationship
Boundaries
Relationship Security / Emotional Safety / Trust
Kindness, Fun & Playfulness
Roles: Division of Labor, Finances, Gender, etc.
Characters Remaining: 350
Characters Remaining: 1000