Full Name

Email *

Phone *

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Captcha

How did you hear about our services?

How did you hear about our services?

• TikTok
• Instagram/Facebook
• Reddit
• Google search
• Referred by a friend
• Other
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• List is empty.

Are you feeling lonely in your relationship? *

Yes, I feel isolated or lonely in my relationship.

I'm mostly happy in my relationship, but sometimes I feel lonely.

I'm not sure if I feel lonely in my relationship.

I am very happy and I do not feel isolated or lonely.

Do you feel like you can trust your partner? *

• Yes, I fully trust my partner.
• I trust my partner in some ways, but not in others.
• No. I do not feel like I can trust my partner.
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Do you feel like you can trust your partner?

Has there been infidelity in your relationship? *

No, neither partner in our relationship has been adulterous

Yes, my partner has been adulterous in our relationship

Yes, I have been adulterous in our relationship

I suspect my partner is cheating

If yes, please share as much as you feel comfortable to.

If you suspect your partner of infidelity, please share as much as you feel comfortable to.

Do you feel there is good communication in your relationship? *

• Yes, I feel like my partner and I communicate well.
• Sometimes. It depends on the subject.
• I'm not sure if my partner and I have good communication
• No, I do not feel like my partner and I communicate well.
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Do any of these situations occur in your relationship?(Check all that apply) *

I often feel unheard during our conflicts.

My partner calls me names or uses personal insults during conflicts.

My partner often gets angry when I set and hold healthy boundaries.

I am afraid to bring up things that bother me in the relationship.

I often choose to "keep the peace" instead of speak my mind.

My partner is often overly affectionate after a heated argument.

None of the Above.

Do struggle to set boundaries in your relationship? *

I can clearly set boundaries that my partner respects

Sometimes I feel like my boundaries are not respected

I often feel like my boundaries are not respected

I struggle to set boundaries at all

Have you ever thought about leaving the relationship? *

• Yes, I often think about leaving the relationship
• Yes, I sometimes think about leaving the relationship.
• I've thought about leaving the relationship once or twice.
• I have never thought about leaving the relationship.
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Have you and your partner received therapy? *

Yes, both of us are currently in therapy.

Yes, I am currently in therapy.

Yes, my partner is currently in therapy.

Yes, one or both of us received therapy in the past.

No, neither of us have ever received professional therapy.

Is there anything you would like to share about your relationship?

Are you interested in joining our online community for more support? *

Yes, I would like more information on joining your online community

I'm not sure yet. I'll have to think about it.

No, I am just here to take the quiz.

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