Couples Survey Questions

First Name *

Last Name *

Your Email *

Partner's Email *

If you do not have please input admin@impact.vision and we will direct to them.

Counselor's Email *

If you do not have please input admin@impact.vision and we will direct to them.

Phone *

Partner: 10-20 years vision *

Mine: 10-20 years vision *

Partner: Favorite foods *

Mine: Favorite foods *

Partner: How Do They Deal With Stress *

Mine: How Do They Deal With Stress *

Partner: What Is Their Pet Peaves *

Mine: What Is Their Pet Peaves *

Partner: What Do They Get Irritated About Most *

Mine: What Do They Get Irritated About Most *

Partner: Anger Level And Why (1 Weak And 10 Strong) *

Mine: Anger Level And Why (1 Weak And 10 Strong) *

Partner: What Turns Them On Romantically *

Mine: What Turns Them On Romantically *

Partner: Spiritual Maturity & Why? (1 Weak And 10 Strong) *

Mine: Spiritual Maturity & Why? (1 Weak And 10 Strong) *

Partner: Most Top 3 Traumatic Childhood Experiences *

Mine: Most Top 3 Traumatic Childhood Experiences *

Partner: Political Party Affiliation And Views *

Mine: Political Party Affiliation And Views *

Partner: Addictions/Bad Habits That Will Most Likely Affect You In Future? *

Mine: Addictions/Bad Habits That Will Most Likely Affect You In Future? *

Partner: Favorite Movies, Songs, And Books? *

Mine: Favorite Movies, Songs, And Books? *

Partner: Who Are The Most Influential People In Your Partner's Life? *

Mine: Who Are The Most Influential People In Your Partner's Life? *

Partner: What Inner Fears Are Driving Them *

Mine: What Inner Fears Are Driving You *

Copy of this correspondence will be emailed to you. Thank you!

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