Relationship & Separation

Questionnaire

Take the First Step Towards Understanding Yourself with Our Questionnaire

This questionnaire gathers information about your emotional state and concerns to enhance our counseling sessions. Answer only the questions you find relevant. Your comfort is our priority, so skip any questions you prefer not to answer.

Consultation Fee(Required)

Price:

Includes:
• Related Questionnaire Assessment.
• Based on the Questionnaire One hour in Detail Consulting Session.
• Finalizing healing quotes (5-7) on the basis of consulting.

Your Name

Full Name

Your Phone

Address

City Country

Gender

Female

Male

Age

Marital Status

Kids

Occupation

What are you trying to solve?(Required)

with siblings →

with friends →

with parents →

with children →

colleague relationship →

bf or gf relationship →

happy relationship →

in laws relationship →

Expert therapy for emotional issues, Counseling for managing emotional stress,Counseling for family emotional health,Relationship therapy for couples,Counseling for emotional crisis,Counseling for anxiety and stress,Counseling for improving relationships,Counseling for overcoming stress,Counseling for emotional recovery,Counseling for parent-child dynamics,Counseling for sibling disputes,Counseling for marital conflicts,Therapy for emotional resilience, Counseling for work stress management,Emotional therapy for personal issues,Counseling for mental and emotional health,Counseling for family relationships, Professional counseling for emotional issues,wall of impact.

with spouse →

,Counseling for emotional stability,Counseling for anxiety management,Professional mental health therapy,Counseling for relationship repair,Counseling for work-life balance, Emotional support therapy,Counseling for dealing with break-ups, Family relationship counselling,Counseling for workplace emotional issues, Counseling for resolving conflicts,Counseling for overcoming anxiety Professional relationship counselling,Counseling for stress relief, Emotional care counselling, Therapy for personal emotional issues,Counseling for healing emotional wounds,Counseling for sibling dynamics,Counseling for spousal conflicts

relationship and separation →

Please choose upto 2 options

Siblings form

Q. How many siblings do you have?

Q. What are the genders of your siblings?

Q. What is your current concern regarding your sibling relationship?

Q. Is this concern recent, or has it been on-going?

Q. What factors have contributed to this concern or emotional state?

Q. How do your other siblings feel about this concern, if they share it?

Q. Have you discussed this concern with the sibling involved?

Q. How did you feel after discussing it, if you did?

Q. Have you noticed any changes in the situation after the discussion?

Q. Have you discussed this concern with your parents, and if so, how do they perceive it?

Q. What is their opinion regarding your feelings about this sibling?

Q. Is there anything specific you would like to share or discuss about your relationship with your sibling and how it is impacting your mental well-being?

Friends Form

Q. What is the specific concern you have regarding your friend?

Q. Has this concern been present for a while, or is it something that has recently emerged? If so, what triggered it?

Q. Is this concern related to a new friend in your life or an old, longstanding friendship?

Q. Are you certain that your friend is aware of this concern?

Q. Have you openly discussed this concern with your friend, and if so, what was the outcome or resolution?

Q. If there are any particular details or nuances you'd like to share about your friendship or the concern you're experiencing, please provide them to help us prepare for our one-hour discussion session.

Relationship With Parents

Q. Is your current concern regarding one parent or both?

Q. If it's specific to one parent, which parent is it?

Q. Has this concern always been present, or is it something that has developed recently?

Q. What do you believe is the reason behind this particular feeling you're experiencing?

Q. Have you discussed this concern with the parent involved?

Q. How did they react to your discussion?

Q. How did you feel after having this conversation?

Q. Have there been any changes in their behavior towards you since the discussion?

Q. What aspect of your relationship with your parent(s) bothers you the most? Are you still emotionally or financially dependent on them?

Q. How would you describe your relationship with your parent(s) during your childhood? Was it friendly, limited, fearful, or based on respect?

Q. Why do you still hold them responsible for childhood traumas, if you do?

Q. If you do blame them, how long have you been managing on your own?

Q. Does your relationship with your parents affect your behavior towards your own children?

Q. Do your parents treat your other siblings differently?(Required)

Yes

Q. If so, why do you believe they treat you differently?

Q. If their feelings towards your siblings differ from yours, what do you think is the reason behind this?

Q. If their responses differ from yours, why do you think they can move on while you struggle to do so?

Relationship With Children

Q. How many children do you have?

Q. What are the genders of your children?

Q. What are the ages of your children?

Q. Do both you and your partner equally divide your attention between your children?

Q. What is your parenting style?

Q. Would you describe yourself as a friendly, strict, overly caring, overly concerned, highly involved, or uninvolved parent?

Q. Do you discuss life experiences with your children, or do your conversations primarily revolve around school, homework, clothes, and food?

Q. Is your parenting approach fostering dependence or independence in your children?

Q. Do you find yourself overly preoccupied with your children's health, nutrition, and academic performance?

Q. Do you sometimes neglect your own needs and those of your spouse due to your focus on your children?

Q. How would you describe the relationship between you and your children? Are they friendly with you?

Q. Do your children feel comfortable discussing a wide range of topics with you, or do they primarily stick to discussing school, homework, clothes, food, and health?

Relationship With In laws

Q. Did you have a love marriage or an arranged marriage?

Q. How long have you been married?

Q. What specific reasons contribute to these feelings towards them?

Q. Have your in-laws always been this way, or have there been changes since your marriage?

Q. Can you describe your overall experience with your in-laws? Has it been consistent or fluctuating?

Q. What do you believe is the reason behind any changes in their behaviour towards you?

Q. How does your spouse perceive the situation with their parents?

Q. How have you approached discussing issues with your in-laws?

Q. Do your in-laws treat their other sons- or daughters-in-law in a similar manner?

Q. If yes, how do those individuals feel? If no, why do you think your situation differs?

Q. How do your in-laws interact with your parents?

Q. How supportive and understanding is your spouse regarding these issues?

Q. What are your expectations regarding the behaviour of your in-laws?

Q. What efforts have you made to earn their love, respect, and attention?

Q. What criticisms or mistakes do your in-laws frequently point out in you?

Q. Do you believe there is validity to their criticisms, or do you perceive them as unjustified?

gf or bf relationship form

Q. How long have you been in this relationship?

Q. What aspects do you like or dislike about your boyfriend/girlfriend?

Q. What specific reasons contribute to these feelings towards them?

Q. Have these feelings been present since the beginning of the relationship or have they developed recently?

Q. Is this your first romantic relationship, or have you had relationships in the past?

Q. Did you experience similar feelings in your previous relationships?

Q. If so, how did you address them in the past?

Q. What were the reasons your previous relationships didn't work out?

Q. How long were you single between your previous relationship and the current one? What attracted you to your current partner?

Q. Do you genuinely feel love for this person, or do other factors, such as loneliness, play a role in your relationship? Do you trust them?

Q. If you trust them, what factors contribute to that trust? If not, what causes your distrust?

Q. Do you perceive your partner as more of a giver or a taker in the relationship? Could you explain your reasoning?

Q. Does your partner prioritize spending quality time with you?

Q. Are your sexual needs being met in this relationship?

Q. Are you considering settling down with this person, or do you view the relationship as temporary?

Q. How did you initially meet your partner?

Colleague relationship

Q. What is your current concern regarding your colleague, and why does it bother you?

Q. Have you experienced feelings of jealousy towards your colleague?

Q. Is this concern affecting your overall job satisfaction or making you dislike your work?

Q. Do you perceive your colleague as having a superior skill set compared to yours?

Q. Are you feeling overlooked or that your colleague is receiving more attention in the workplace?

Q. Can you provide more details about the nature of this concern? Is it a recent issue, or has it been ongoing? Has it been present in previous jobs as well? If so, how did you handle it? What is your current relationship status with this colleague?

happy relationship

Q. How would you describe the overall atmosphere and dynamic of your relationship?

Q. What are some qualities or characteristics about your partner that make you feel happy and fulfilled?

Q. How do you and your partner communicate with each other, especially during times of disagreement or conflict?

Q. Do you feel supported and respected by your partner in pursuing your goals and interests?

Q. What are some shared experiences or activities that bring joy and excitement into your relationship?

Q. Do you feel like your emotional needs are met and understood by your partner?

Q. Are there any challenges or obstacles in your relationship, and how do you navigate them together?

Q. How do you maintain a healthy balance between independence and togetherness in your relationship?

Q. How did you feel after discussing it, if you did?

Q. Can you envision a future with your partner that brings you happiness and fulfillment?

Husband-Wife Relationship Questionnaire

Personal Information:

Q. Names of both spouses:

Q. Ages of both spouses:

Q. Duration of marriage:

Q. Number of children (if applicable):

Q. Occupation and work schedule of each spouse:

Communication and Connection:

Q. How would you describe the overall communication between you and your spouse?

Q. How often do you engage in meaningful conversations or discussions about your relationship, goals, and dreams?

Q. Do you feel heard and understood by your spouse? Please elaborate.

Q. How do you typically resolve conflicts or disagreements in your relationship?

Emotional Intimacy and Support:

Q. How do you express affection and emotional support to each other?

Q. Do you feel emotionally connected and supported by your spouse during challenging times?

Q. What activities or gestures strengthen your emotional bond with your spouse?

Roles and Responsibilities:

Q. How do you divide household chores and responsibilities?

Q. Are there specific roles or tasks that each spouse typically takes on? Please describe.

Q. How do you navigate decisions regarding finances, parenting, and other major life choices?

Quality Time and Activities:

Q. How often do you spend quality time together as a couple?

Q. What are your favourite activities or hobbies to do together?

Q. How do you maintain a sense of adventure and spontaneity in your relationship?

Sexual Intimacy and Satisfaction:

Q. How would you rate the level of intimacy and satisfaction in your sexual relationship?

Q. How do you communicate about sexual needs and desires with your spouse?

Q. Are there any challenges or concerns related to sexual intimacy that you would like to address?

Supporting Each Other's Growth:

Q. How do you support each other's personal growth and individual goals?

Q. Do you encourage each other to pursue hobbies, interests, or career aspirations?

Q. How do you handle differences in personal aspirations and ambitions within the relationship?

Handling Conflict and Challenges:

Q. What are the typical sources of conflict or tension in your marriage?

Q. How do you work through disagreements or misunderstandings?

Q. Are there any unresolved issues or recurring patterns of conflict that you would like to address?

Family Dynamics and In-Laws:

Q. How do you navigate relationships with each other's families and in-laws?

Q. Are there any challenges or dynamics related to extended family that impact your relationship?

Coping with Stress and Adversity:

Q. How do you support each other during periods of stress, illness, or adversity?

Q. What strategies or rituals do you have for maintaining resilience and unity as a couple?

Future Goals and Aspirations:

Q. How do you envision your future together as a couple?

Q. Are there specific goals or dreams that you aspire to achieve together?

Q. How do you plan for long-term financial stability and retirement?

Reflection and Growth:

Q. What are the strengths of your marriage that you appreciate and value?

Q. In what areas do you feel there is room for growth and improvement in your relationship?

Q. How do you prioritize the on-going growth and nurturing of your marriage?

Q. Is there anything else you would like to share about your marriage, experiences, challenges, or aspirations as a couple?

Relationship and Separation

Q. Who is the person you are currently separated from, and what is your relationship with them (e.g., spouse, sibling, parent, friend)?

Q. What circumstances led to the physical separation from your loved one?

Q. How long have you been physically apart from this person, and when did you first realize the impact of this separation on your emotional well-being?

Emotional Impact and Coping

Q. What emotions do you experience when thinking about or interacting with the person you're apart from (e.g., longing, sadness, joy)?

Q. How would you describe your emotional state since being separated from your loved one?

Q. What strategies or activities do you use to cope with the emotional challenges of separation?

Q. How has the separation influenced your daily routines and activities?

Communication and Connection

Q. When and how often do you communicate with the person you're separated from?

Q. How does staying in touch with your loved one impact your emotional state?

Q. Are there specific ways you and your loved one maintain a sense of connection despite the physical distance?

Reflection and Future Outlook

Q. Why do you believe maintaining this relationship is important despite the distance?

Q. How do you envision your future relationship with this person once the separation ends?

Q. What lessons or insights have you gained about yourself and your relationship during this period of separation?

Q. Are there any goals or plans you have for reuniting or spending time together in the future?

Support and Self-Care

Q. Who else is affected by this separation (e.g., other family members, children, friends)?

Q. How do you prioritize self-care and emotional well-being while separated from the person you love?

Choose Your Healer(Required)

GEETIKA ARORA, Master's in Clinical Psychology, 6+ years experience

RANINA NAJEEB, Msc Psychology and Master Programme in CBT (Cognitive Behaviour Therapy), 2 years experience

KAUSAR SHEIKH, Masters in Clinical Psychology, 27 years experience

HARPREET KAUR, MSc Psychology, 11+ years experience

NEELU SINGHVI, Advanced Diploma In Child Guidance And Counselling, 9 years experience

BHAGYASRI YALKAR SAVYELL, MA in Clinical Psychology, 17 years experience

KAJAL DAGA, RCI Licensed Psychologist, MA Clinical Psychology, Advanced Diploma in Child Guidance and Counseling, 5 years experience