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Couples Therapy Questionnaire

What kind of support do you believe would help your relationship the most?

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What kind of support do you believe would help your relationship the most?

Solution-Oriented

Deep Exploration and Self-Discovery

Space to Express and Be Heard Conflict Resolution

Building Strength and Motivation as a Couple

Behavioural Management (for couples)

Personality Development

Improving Communication and Social Dynamics

Relaxation and Mindfulness

Conflict Resolution

Select the languages you are comfortable taking therapy in

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Select the languages you are comfortable taking therapy in

Hindi

English

Marathi

Kannada

Other

What kind of personality traits do you prefer in your therapist?

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What kind of personality traits do you prefer in your therapist?

Calm and Reassuring

Direct & Analytical

Humorous & Extroverted

Supportive & Encouraging

5. Understanding Your Relationship Concerns (Select all that apply)

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5. Understanding Your Relationship Concerns (Select all that apply)

A

Communication Problems

B

Frequent Arguments

C

Trust Issues

D

Intimacy Concerns

E

Life Transitions (e.g., marriage, moving, parenting)

F

Emotional Distance

G

Infidelity

H

Managing External Stress

I

Parenting Conflicts

J

Financial Stress

K

Cross-Cultural Differences

L

LGBTQ+Relationship Concerns

M

Future Planning Difficulties

On a scale of 1–5, how severe do you consider your relationship concerns to be?

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On a scale of 1–5, how severe do you consider your relationship concerns to be?

1

2

3

4

5

How often do conflicts or disagreements occur between you and your partner currently?

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How often do conflicts or disagreements occur between you and your partner currently?

Rarely

Occasionally

Frequently

Almost Daily

Please enter your name

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Please enter your email id

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Please enter your contact number

*

Please enter your age

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Please enter your partners age

*

Please enter your gender

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Please enter your gender

Male

Female

Non-binary

Prefer not to say

Please enter your partner's gender

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Please enter your partner's gender

Male

Female

Non-binary

Prefer not to say

Please enter your relationship status

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Please enter your relationship status

Married

In a committed relationship

Engaged

Living together

Other