Marriage Satisfaction Form

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A. Please list ten things which your partner does which please you:


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B. Please list three things you would like your partner to do more often. Check mark the box under the days, indicating how often he/she did each of these things during the past seven days.








C. List Three Things you think your partner would like you to do for him/her. Check mark the box under the days, indicating how often he/she did each of these things during the past seven days.








D. List five interests which you and your partner share. Select how often you do these thing together.












E. List five of your own interests. Select how often you do these.












F. List five positive characteristics of your partner and five positive characteristics of yourself.

Partner





Self






G. List what you would like to change about yourself.







H. In what ways have I been showing or giving love lately?






I. Overall, on a scale of 0-10, (0=very dissatisfied and 10= very satisfied), rate the following:

1. How satisfied do you think your partner is with your relationship?:

2. How satisfied are you with you relationship?


J. List three things which you believe would improve your satisfaction with your relationship.





K. List three things which you believe would improve your partner’s satisfaction with your relationship.





L. Overall, on a scale of 0-10, (0=very dissatisfied and 10= very satisfied), rate the following:

1. How committed do you think your partner is to working on this relationship?

2. How committed are you to working on this relationship?

3. How committed do you think your partner is to making changes to improve the relationship?

4. How committed are you to making changes to improve the relationship?


M. What proportion of the time spent with you is happy for your partner, in your opinion?

N. What amount of the time spent with your partner is happy for you?

O. How much happier do you think your partner expects to be?

P. How much happier do you expect to be as time goes on or with therapy?

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Gottman Approach to Marriage Therapy

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Dr.'s John and Julie Gottman have developed tools to take your marriage or your relationship with your partner from VOW to WOW! John has been studying what makes happy marriages happy. He discovered, it is not so much how you manage conflicts, but how you interact with each other on a daily basis. Join us for this one day seminar, it will revolutionize your marriage or relationship with your partner.

  • Help restore trust
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