Exit this survey Relationship Counseling Info Request Question Title * 1. Name, Age Question Title * 2. Phone & E-mail address Question Title * 3. City/State/Country Question Title * 4. Partner's Name, Age Question Title * 5. Partner's Phone & Email Question Title * 6. Which best describes you situation? Married Engaged Living Together Separated Divorced Other (please specify) Question Title * 7. How would your satisfaction in your current relationship? Not satisfied at all. Not so good. Average, I guess. Pretty good. Great! but could get better! Not satisfied at all. Not so good. Average, I guess. Pretty good. Great! but could get better! Question Title * 8. How long have you been in this relationship? I'm just getting started. Less than a year. Less than 4 years. less than 8 years. Over 8 years. Question Title * 9. Have you been to counseling before? Done