Marriage and Family Therapy Clinic
Department of Human Development and Family Studies
(515) 294-0534

Funded by GSB

Relationship Check-Up

This on-line questionnaire provides you with a relationship check-up. The questionnaire has been frequently used in research studies because it seems to provide a reliable measure of relationship satisfaction.

Click your response to the following 32 questions. At the end of the questionnaire, click the "Submit" button to see your results which will be calculated immediately.

If you are interested in therapy at the ISU Marriage & Family Therapy Clinic, call (515)294-0534 for an appointment, or email Dr. Megan Murphy at mjmurphy@iastate.edu for more information about therapy services.

Please answer every question.

Most people have disagreements in their relationships. Please indicate below the approximate extent of agreement or disagreement between you and your partner for each item based on the following scale:

5 = Always agree
4 = Almost always agree
3 = Occasionally disagree
2 = Frequently disagree
1 = Almost always disagree
0 = Always disagree

1.	Handling family finances	5 4 3 2 1 0
2.	Matters of recreation	5 4 3 2 1 0
3.	Religious matters	5 4 3 2 1 0
4.	Demonstrations of affection	5 4 3 2 1 0
5.	Friends	5 4 3 2 1 0
6.	Sex relations	5 4 3 2 1 0
7.	Conventionality (Correct or proper behavior)	5 4 3 2 1 0
8.	Philosophy of life	5 4 3 2 1 0
9.	Ways of dealing with parents or in-laws	5 4 3 2 1 0
10.	Aims, goals, and things believed important	5 4 3 2 1 0
11.	Amount of time spent together	5 4 3 2 1 0
12.	Making major decisions	5 4 3 2 1 0
13.	Household tasks	5 4 3 2 1 0
14.	Leisure time interest and activities	5 4 3 2 1 0
15.	Career decisions	5 4 3 2 1 0

The following questions have different answers. Please read the questions and answers carefully. Now, please indicate below approximately how often the following items occur between you and your partner based on this scale:

0 = All the time
1 = Most of the time
2 = More often than not
3 = Occasionally
4 = Rarely
5 = Never

16.	How often do you discuss or have you considered divorce, separation or terminating your relationship?	5 4 3 2 1 0
17.	How often do you or your partner leave the house after a fight?	5 4 3 2 1 0
18.	In general, how often do you think that things between you and your partner are going well?	5 4 3 2 1 0
19.	Do you confide in your mate?	5 4 3 2 1 0
20.	Do you ever regret that you married (or lived together)?	5 4 3 2 1 0
21.	How often do you and your partner quarrel?	5 4 3 2 1 0
22.	How often do you and your partner "get on each other's nerves?"	5 4 3 2 1 0

How often would you say the following events occur between you and your partner?

23. How often do you kiss your mate?

0 = Never
1 = Rarely
2 = Occasionally
3 = Almost Every Day
4 = Every Day

24. How many outside interests do you and your partner engage in together?

0 = None of them
1 = Very few of them
2 = Some of them
3 = Most of them
4 = All of them

How often would you say the following events occur between you and your partner, based on the following scale:

0 = Never
1 = Less than once a month
2 = Once or twice a month
3 = Once or twice a week
4 = Once a day
5 = More often

25.	Have a stimulating exchange of ideas	5 4 3 2 1 0
26.	Laugh together	5 4 3 2 1 0
27.	Calmly discuss something	5 4 3 2 1 0
28.	Work together on a project	5 4 3 2 1 0

There are some things about which couples sometimes agree and sometimes disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks. (Click "yes" or "no")

yes no	29. Being too tired for sex.
yes no	30. Not showing love.

The numbers below represent different degrees of happiness in your relationship. The middle point, "happy." represents the degree of happiness of most relationships. Please select the number which best describes the degree of happiness, all things considered, of your relationship.

0	1	2	3	4	5	6
Extremely Unhappy	Fairly Unhappy	A Little Unhappy	Happy	Very Happy	Extremely Happy	Perfect

Which of the following statements best describes how you feel about the future of your relationship?

5	I want desperately for my relationship to succeed, and would go to almost any length to see that it does.
4	I want very much for my relationship to succeed, and will do all I can to see that it does.
3	I want very much for my relationship to succeed, and will do my fair share to see that it does.
2	It would be nice if my relationship succeeded, but I can't do much more than I am doing now to help it succeed.
1	It would be nice if it succeeded, but I refuse to do any more than I am doing now to keep the relationship going.
0	My relationship can never succeed, and there is no more that I can do to keep the relationship going.

Before submitting your results, please answer the following questions:

How old were you on your last birthday? Please enter a number rather than text:
Which best describes your current relationship? Heterosexual relationship Homosexual relationship Other
How many years have you been in your current relationship? Please enter a number rather than text. If you would like, you may use a decimal (e.g., .5 for half of one year ):

Now, press the "Submit" button to see your results which will be calculated immediately