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COUPLE RATING SCALE
Click Here to answer this questionnaire online
Instructions:
Rating scale is from 1 to 10 with 1 being the lowest and 10 the highest. You will rate yourself in the first column. In column one, rate your CURRENT level of each trait. Column two is for rating your partner. In column two, using your PERSONAL PERCEPTION, rate his/her CURRENT level of each trait.
LIFE AREA |
SELF CURRENT |
PARTNER CURRENT |
||
| COMMUNICATION LIFE | ________ |
________ | ||
| Degree of listening skill | ________ | ________ | ||
| Degree of sensitivity and respect | ________ | ________ | ||
| Degree of honesty | ________ | ________ | ||
| Degree of openness | ________ | ________ | ||
| Degree of flexibility/compromise | ________ | ________ | ||
| HOME LIFE | ||||
| Degree of satisfaction with household responsibilities | ________ | ________ | ||
| Degree of completing household responsibilities | ________ | ________ | ||
| Degree of role flexibility | ________ | ________ | ||
| Degree of good parenting skills | ________ | ________ | ||
| WORK LIFE | ||||
| Degree of fulfillment in own career | ________ | ________ | ||
| Degree of comfort with partner's career | ________ | ________ | ||
| Degree of balance between work/home life | ________ | ________ | ||
| LOVE LIFE | ||||
| Degree of acceptance of other | ________ | ________ | ||
| Degree of mutual understanding | ________ | ________ | ||
| Degree of trust in other | ________ | ________ | ||
| Degree of expressed (spoken) love | ________ | ________ | ||
| Degree of Implied (unspoken) love | ________ | ________ | ||
| Degree of forgiveness in relationship | ________ | ________ | ||
| SEXUAL LIFE | ||||
| Degree of frequency | ________ | ________ | ||
| Degree of satisfaction | ________ | ________ | ||
| Degree of excitement in lovemaking | ________ | ________ | ||
| Degree of variety In lovemaking | ________ | ________ | ||
| SPIRITUAL LIFE | ||||
| Degree of spiritual belief | ________ | ________ | ||
| Degree of religious practice | ________ | ________ | ||
| Degree of comfort with spiritual expression | ________ | ________ | ||
| PROBLEM SOLVING LIFE | ||||
| Ability to talk about problems (get them in the open) | ________ | ________ | ||
| Ability to work through problems | ________ | ________ | ||
| Ability to "fight fair" | ________ | ________ | ||
| Ability to resolve family-of-origin problems | ||||
| DREAM FOR THE FUTURE LIFE | ||||
| Degree that your dream is also his/hers | ________ | ________ | ||
| Degree that your dream is mutually decided | ________ | ________ | ||
| TOTALS FOR EACH COLUMN | ________ | ________ |
