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Relationship Satisfaction & Connection Check-In

Measures how satisfied partners are with communication, intimacy, trust, and shared responsibilities in their relationship, with an AI follow-up that digs into the specific moment or pattern behind their lowest-rated area rather than settling for a generic label.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

13 questions · ~7 min
Q01
Message

Thanks for taking a few minutes to reflect on your relationship. This check-in covers communication, trust, intimacy, and day-to-day teamwork — there are no right answers, just your honest experience. About 5-6 minutes.

Q02
Opinion ScaleRequired

Overall, how satisfied are you with your relationship right now?

Scale: 0 – 10
Min:Not at all satisfiedMax:Extremely satisfied
Q03
MatrixRequired

How satisfied are you with each of these areas of your relationship?

7 rows × 5 columns
  • Communication
  • Trust
  • Emotional intimacy
  • Physical intimacy
  • Division of chores/responsibilities
  • +2 more
Columns: Very dissatisfied · Dissatisfied · Neutral · Satisfied · Very satisfied
Q04
Multiple ChoiceRequired

In the last 30 days, how often did you and your partner have a meaningful conversation (not just logistics) about your relationship or feelings?

  • Not at all
  • Once or twice
  • Weekly
  • Several times a week
  • Almost daily
Q05
Multiple ChoiceRequired

In the last 30 days, how did most disagreements between you and your partner typically end?

  • Resolved with both feeling heard
  • Resolved but one side gave in
  • Left unresolved but dropped
  • Escalated or repeated later
  • We had no disagreements
Q06
Rating ScaleRequired

How would you rate your partner's effort in making you feel valued and appreciated?

Range: 1 – 5
Min:Very low effortMax:Very high effort
Q07
Ranking

Rank these areas from most to least in need of improvement in your relationship right now.

  1. Communication
  2. Trust
  3. Emotional intimacy
  4. Physical intimacy
  5. Sharing responsibilities
  6. Handling conflict
  7. Quality time together
Drag to rank
Q08
Multiple ChoiceRequired

Thinking about the next year, how do you feel about the future of this relationship?

  • Very optimistic
  • Somewhat optimistic
  • Uncertain
  • Somewhat pessimistic
  • Very pessimistic
Q09
AI Interview

Identify the respondent's lowest-rated area from the satisfaction battery and reconstruct a specific recent moment tied to it — what happened, how each partner responded, and what they wished had gone differently. If they rated everything highly, probe instead for one thing that could still quietly become a problem if unaddressed, anchoring on a concrete recent example rather than a general feeling.

Q10
Long Text

Is there anything about your relationship you haven't had a chance to say here that feels important to add?

Q11
Multiple Choice

How long have you and your partner been together?

  • Less than 6 months
  • 6 months to 2 years
  • 2 to 5 years
  • 5 to 10 years
  • More than 10 years
  • Prefer not to say
Q12
Multiple Choice

What is your relationship status?

  • Dating
  • Living together
  • Engaged
  • Married
  • Other
  • Prefer not to say
Q13
Message

Thank you for reflecting so openly. Your responses will be combined with others (anonymously, if part of a group study) to highlight patterns in relationship strengths and areas worth extra attention.

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Goes beyond a satisfaction score by using an AI follow-up interview that targets the respondent's specific lowest-rated area and asks about the actual moment or pattern behind it, rather than stopping at a generic label
  • Covers the full relationship picture in one flow: a satisfaction matrix across communication, intimacy, trust, and shared responsibilities, plus conversation frequency, disagreement style, partner effort, and a forward-looking outlook question
  • Includes a ranking question so respondents prioritize which areas most need improvement, giving structure the AI follow-up can act on
  • Ends with an open-ended long-text prompt so respondents can add anything the structured questions didn't capture, alongside a transparent closing message about how responses will be used

Jotform

Relationship Satisfaction Survey Form Template

A ready-to-use, static form template covering relationship satisfaction that can be customized with Jotform's form builder and integrated with its broader ecosystem (payments, notifications, etc.). It's a fixed question set rather than an adaptive interview, so every respondent sees the same questions regardless of their answers.

What it does well

  • Fielding-ready template usable immediately without survey design work
  • Benefits from Jotform's mature drag-and-drop form builder and integrations
  • Easy to embed or share via link, common for personal or coaching use cases

Where it falls short

  • Static question set with no adaptive follow-up into a respondent's lowest-rated area
  • No automated per-response quality scoring or AI-generated analysis reports
  • No voice AI interview option or guided task/screen-share capability

SurveySparrow

Relationship Satisfaction Survey Template Online

A conversational-style survey template that presents relationship satisfaction questions one at a time, which reads more naturally than a traditional grid form. It's still a predefined script, though, so it can't probe deeper based on what a specific respondent says about their lowest-rated area.

What it does well

  • Conversational one-question-at-a-time UI that feels less clinical than a standard form
  • Fielding-ready template available immediately in SurveySparrow's library
  • Supports basic branching logic within its no-code builder

Where it falls short

  • No true adaptive AI interviewer digging into the specific moment or pattern behind a low score
  • No transparent, publishable prompt methodology or automated quality scoring per response
  • No voice AI interview mode or guided screen-share task option

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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