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Relationship Riches Survey


Welcome to the Relationship Riches Survey for singles.The purpose of this survey is to help you realize the Rich Relationship that you seek.

Please fill out the form, print and send to me by regular mail or e-mail depending upon how you receive this survey. If you fill out this survey on my website you are entitled to a free 30 minute session to discuss the results.

The focus of this survey will be on areas of compatibility, past relationship patterns, your needs and values, your boundaries and some how to�s on creating a life and finding a partner to fit into that life.

Relationship Patterns

1. When I think of the past I feel that all loose ends are tied.
Yes
No

2. When I think of my parents I know I have made peace with them and all aspect of my childhood.
Yes
No

3. I is aware of the why behind my choices.
Yes
No

4. When I am in a relationship I feel comfortable and not driven to do or not to do certain things.
Yes
No

5. My life seems basically organized and complete, ready for a partner to come in.
Yes
No

6. There are no gaps in my relationship knowledge, I know what works and what does not work and I am not surprised of the consequences.
Yes
No

7. I am comfortable with the way my relationships have gone in the past and the way they continue to progress.
Yes
No

Score =
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What are Your Needs

1. I know what needs are and I understand my own.
Yes
No

2. I know how a partner can meet my needs.
Yes
No

3. I know what type of partner I need to meet my needs.
Yes
No

4. I know my top ten needs and how to meet them and care for myself.
Yes
No

5. I take care of my needs weekly.
Yes
No

6. I understand the importance of support in a relationship and I know how to give and receive it.
Yes
No

7. I understand the importance of validation in a relationship and I know how to give and receive it.
Yes
No

Score =
���

Boundaries and Space Between Others and Me

1. I understand the idea of boundaries and I know where mine are drawn.
Yes
No

2. I understand the importance of boundaries in a relationship.
Yes
No

3. I do not have difficulty with boundaries in a relationship.
Yes
No

4. I do not have difficulty with boundaries outside of a relationship.
Yes
No

5. When my boundaries are not respected I can cope with the issue and resolve it in a relationship.
Yes
No

6. I am comfortable with my boundaries as they are.
Yes
No

7. I do not need to revise my boundaries, I am certain they are appropriate for me and for my presence in a relationship.
Yes
No�

Score =

The Relationship

1. I understand what my relationship would be.
Yes
No

2. I know what makes me happy in a relationship.
Yes
No

3. I know what I value in a relationship.
Yes
No

4. I can describe what a day in a good relationship would be about.
Yes
No

5. I understand what I can and what I cannot live with.
Yes
No

6. I have learned much from my past patterns.
Yes
No

7. I understand what I have learned from the past and I no longer have conflict with that.
Yes
No

Score =

If you have answered yes to at least 4 out of every 7 you are doing well although a 30-minute consultation might help you do better. If you have answered yes to less than 4 out of each section please consider relationship coaching.

Remember, sometimes we can be tempted to want to hold onto our ideas, conceptions, creations and understanding of how things ought to be or even how we expect things to be.All of us are tempted to keep ideas and beliefs that result in anxiety and other problems. You have taken the first step in realizing that you don�t have to settle for that!

If you fill out this survey, you are entitled to a free 30 minute session to discuss the results. Please print this page and send it to me by regular mail or e-mail depending upon how you receive this survey.


Note: This program is the property of Coach Rosa. Any other use of this program without prior permission is prohibited.


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