Form: Couples Satisfaction Index, CSI

1. Please indicate the degree of happiness, all things considered, of your relationship.
Extremely Unhappy
Fairly Unhappy
A Little Unhappy
Happy
Very Happy
Extremely Happy
Perfect
2. Amount of time spent together
Always Agree
Almost Always Agree
Occasionally Disagree
Frequently Disagree
Almost Always Disagree
Always Disagree
3. Making major decisions
Always Agree
Almost Always Agree
Occasionally Disagree
Frequently Disagree
Almost Always Disagree
Always Disagree
4. Demonstrations of affection
Always Agree
Almost Always Agree
Occasionally Disagree
Frequently Disagree
Almost Always Disagree
Always Disagree
5. In general, how often do you think that things between you and your partner are going well?
All the time
Most of the time
More often than not
Occasionally
Rarely
Never
6. How often do you wish you hadn't gotten into this relationship?
All the time
Most of the time
More often than not
Occasionally
Rarely
Never
7. I still feel a strong connection with my partner
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
8. If I had my life to live over, I would marry (or live with / date) the same person
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
9. Our relationship is strong
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
10. I sometimes wonder if there is someone else out there for me
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
11. My relationship with my partner makes me happy
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
12. I have a warm and comfortable relationship with my partner
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
13. I can't imagine ending my relationship with my partner
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
14. I feel that I can confide in my partner about virtually anything
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
15. I have had second thoughts about this relationship recently
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
16. For me, my partner is the perfect romantic partner
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
17. I really feel like part of a team with my partner
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
18. I cannot imagine another person making me as happy as my partner does
Not at all True
A little True
Somewhat True
Mostly True
Almost Completely True
Completely True
19. How rewarding is your relationship with your partner?
Not at all
A little
Somewhat
Mostly
Almost Completely
Completely
20. How well does your partner meet your needs?
Not at all
A little
Somewhat
Mostly
Almost Completely
Completely
21. To what extent has your relationship met your original expectations?
Not at all
A little
Somewhat
Mostly
Almost Completely
Completely
22. In general, how satisfied are you with your relationship?
Not at all
A little
Somewhat
Mostly
Almost Completely
Completely
23. How good is your relationship compared to most?
0 : Worse than all others (Extremely bad)
1
2
3
4
5 : Better than all others (Extremely good)
24. Do you enjoy your partner's company?
Never
Less than once a month
Once or twice a month
Once or twice a week
Once a day
More often
25. How often do you and your partner have fun together?
Never
Less than once a month
Once or twice a month
Once or twice a week
Once a day
More often
26. My relationship is:
5 : Interesting
4
3
2
1
0 : Boring
27. My relationship is:
5 : Bad
4
3
2
1
0 : Good
28. My relationship is:
5 : Full
4
3
2
1
0 : Empty
29. My relationship is:
5 : Lonely
4
3
2
1
0 : Friendly
30. My relationship is:
5 : Sturdy
4
3
2
1
0 : Fragile
31. My relationship is:
5 : Discouraging
4
3
2
1
0 : Hopeful
32. My relationship is:
5 : Enjoyable
4
3
2
1
0 : Miserable

The presented answer sheet is not an original form and is not intended for printing or use as a handout.