Q01
Message
All templatesIndustry-Specific
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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
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.
- Communication
- Trust
- Emotional intimacy
- Physical intimacy
- Sharing responsibilities
- Handling conflict
- 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 TemplateA 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 OnlineA 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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