

Extremely comfortable | Somewhat comfortable | Neutral | Somewhat uncomfortable | Extremely uncomfortable |
|
---|---|---|---|---|---|
Extremely comfortable |
Somewhat comfortable |
Neutral |
Somewhat uncomfortable |
Extremely uncomfortable |
How effectively do you honor and communicate your needs and wants?

Extremely effectively | Somewhat effectively | Neutral | Somewhat ineffectively | Extremely ineffectively |
|
---|---|---|---|---|---|
Extremely effectively |
Somewhat effectively |
Neutral |
Somewhat ineffectively |
Extremely ineffectively |
How well do you feel you love and care for yourself?

Extremely well | Somewhat well | Neutral | Somewhat poorly | Extremely poorly |
|
---|---|---|---|---|---|
Extremely well |
Somewhat well |
Neutral |
Somewhat poorly |
Extremely poorly |
How well have you worked on resolving unhealthy relationship patterns?

Extremely well | Somewhat well | Neutral | Somewhat poorly | Extremely poorly |
|
---|---|---|---|---|---|
Extremely well |
Somewhat well |
Neutral |
Somewhat poorly |
Extremely poorly |
How available and free are you to invest emotionally in a new relationship?

Extremely available | Somewhat available | Neutral | Somewhat unavailable | Extremely unavailable |
|
---|---|---|---|---|---|
Extremely available |
Somewhat available |
Neutral |
Somewhat unavailable |
Extremely unavailable |
How comfortable are you with dropping your defenses and being vulnerable in a relationship?

Extremely comfortable | Somewhat comfortable | Neutral | Somewhat uncomfortable | Extremely uncomfortable |
|
---|---|---|---|---|---|
Extremely comfortable |
Somewhat comfortable |
Neutral |
Somewhat uncomfortable |
Extremely uncomfortable |
How well do you feel you have healed and made peace with past relationship experiences?

Extremely well | Somewhat well | Neutral | Somewhat lacking | Extremely lacking |
|
---|---|---|---|---|---|
Extremely well |
Somewhat well |
Neutral |
Somewhat lacking |
Extremely lacking |
How consistent are you in expressing true self-love and self-acceptance?

Extremely consistentc | Somewhat consistent | Neutral | Somewhat inconsistent | Extremely inconsistent |
|
---|---|---|---|---|---|
Extremely consistentc |
Somewhat consistent |
Neutral |
Somewhat inconsistent |
Extremely inconsistent |
How fully have you faced, owned, and resolved your own relationship patterns?

Extremely well | Somewhat well | Neutral | Somewhat incomplete | Extremely incomplete |
|
---|---|---|---|---|---|
Extremely well |
Somewhat well |
Neutral |
Somewhat incomplete |
Extremely incomplete |
How emotionally available do you feel you truly are for a new relationship?

Extremely available | Somewhat available | Neutral | Somewhat unavailable | Extremely unavailable |
|
---|---|---|---|---|---|
Extremely available |
Somewhat available |
Neutral |
Somewhat unavailable |
Extremely unavailable |
How receptive do you feel to accepting love and affection from a new partner?

Extremely respective | Somewhat respective | Neutral | Somewhat unreceptive | Extremely unreceptive |
|
---|---|---|---|---|---|
Extremely respective |
Somewhat respective |
Neutral |
Somewhat unreceptive |
Extremely unreceptive |
How willing are you to let go of control and attachment to allow your next relationship to unfold naturally?

Extremely willing | Somewhat willing | Neutral | Somewhat unwilling | Extremely unwilling |
|
---|---|---|---|---|---|
Extremely willing |
Somewhat willing |
Neutral |
Somewhat unwilling |
Extremely unwilling |
How comfortable and safe do you feel with prospective intimacy and closeness in a new relationship?

Extremely comfortable | Somewhat comfortable | Neutral | Somewhat uncomfortable | Extremely uncomfortable |
|
---|---|---|---|---|---|
Extremely comfortable |
Somewhat comfortable |
Neutral |
Somewhat uncomfortable |
Extremely uncomfortable |
How easily do you feel being able to compromise and accommodate the needs of a new partner?

Extremely easily | Somewhat easily | Neutral | Somewhat uneasily | Extremely uneasily |
|
---|---|---|---|---|---|
Extremely easily |
Somewhat easily |
Neutral |
Somewhat uneasily |
Extremely uneasily |
How well do you feel you effectively communicate your emotional needs in a relationship?

Extremely effectively | Somewhat effectively | Neutral | Somewhat ineffectively | Extremely ineffectively |
|
---|---|---|---|---|---|
Extremely effectively |
Somewhat effectively |
Neutral |
Somewhat ineffectively |
Extremely ineffectively |
How willing are you to invest your time and effort into building a new relationship?

Extremely willing | Somewhat willing | Neutral | Somewhat unwilling | Extremely unwilling |
|
---|---|---|---|---|---|
Extremely willing |
Somewhat willing |
Neutral |
Somewhat unwilling |
Extremely unwilling |
How well do you handle conflicts, arguments, and disagreements in relationships?

Extremely well | Somewhat well | Neutral | Somewhat poorly | Extremely poorly |
|
---|---|---|---|---|---|
Extremely well |
Somewhat well |
Neutral |
Somewhat poorly |
Extremely poorly |
How trusting do you feel, and how safe do you feel to be in a relationship with a potential new partner?

Extremely trusting | Somewhat trusting | Neutral | Somewhat untrusting | Extremely untrusting |
|
---|---|---|---|---|---|
Extremely trusting |
Somewhat trusting |
Neutral |
Somewhat untrusting |
Extremely untrusting |
How open and comfortable do you feel to share your life and space with a new partner?

Extremely open | Somewhat open | Neutral | Somewhat closed | Extremely closed |
|
---|---|---|---|---|---|
Extremely open |
Somewhat open |
Neutral |
Somewhat closed |
Extremely closed |
How willing are you to let go of past relationship patterns and embrace new ways of being in a relationship?

Extremely willing | Somewhat willing | Neutral | Somewhat unwilling | Extremely unwilling |
|
---|---|---|---|---|---|
Extremely willing |
Somewhat willing |
Neutral |
Somewhat unwilling |
Extremely unwilling |
How emotionally comfortable and open do you feel
since your breakup?

Extremely comfortable | Somewhat comfortable | Neutral | Somewhat uncomfortable | Extremely uncomfortable |
|
---|---|---|---|---|---|
Extremely comfortable |
Somewhat comfortable |
Neutral |
Somewhat uncomfortable |
Extremely uncomfortable |
How open and clear do you feel meeting new people and
forming new romantic connections?

Extremely open | Somewhat open | Neutral | Somewhat closed | Extremely closed |
|
---|---|---|---|---|---|
Extremely open |
Somewhat open |
Neutral |
Somewhat closed |
Extremely closed |
How fully do you feel you have processed and resolved your emotional baggage from your past relationship?

Extremely fully | Somewhat fully | Neutral | Somewhat poorly | Extremely poorly |
|
---|---|---|---|---|---|
Extremely fully |
Somewhat fully |
Neutral |
Somewhat poorly |
Extremely poorly |
How actively are you involved with personal healing, growth,
and studying self-improvement?

Extremely active | Somewhat active | Neutral | Somewhat inactive | Extremely inactive |
|
---|---|---|---|---|---|
Extremely active |
Somewhat active |
Neutral |
Somewhat inactive |
Extremely inactive |
How committed are you to invest your time and energy
in a new relationship?

Extremely committed | Somewhat committed | Neutral | Somewhat uncommitted | Extremely uncommitted |
|
---|---|---|---|---|---|
Extremely committed |
Somewhat committed |
Neutral |
Somewhat uncommitted |
Extremely uncommitted |




