Relationship Questionnaire

Take this Questionnaire and I’ll provide you with a free, confidential assessment of your relationship.

Who will benefit from my Intensive Retreats? Couples of all kinds! Maybe you’ve tried couples counseling and you are just not seeing the results that you had hoped for. Or, perhaps you think that you might need counseling, but you don’t know where to begin. Maybe you don’t know how to approach your partner. For more than 20 years, I’ve counseled married and committed couples of all ages and types, from traditionally married to those in same-sex relationships. Will my intensive relationship retreat benefit you and your partner? I would be happy to discuss this with you, but first, take a few moments and fill out this CONFIDENTIAL questionnaire. This is for you to fill out and should reflect your views on the current status and issues in your relationship, not what you suppose your partner’s to be. Your responses will kept in complete confidence and be treated with professionalism and compassion.

Once you’ve done that, I’ll spend a few days analyzing your answers and will get back to you via email to discuss the next steps in reviving your relationship. I’ll also tell you if and how I think you and your partner might benefit from my Intensive Couples Retreat Weekend. You can ask me questions and we can discuss retreat dates and locations that fit your schedule.

Dr. Brawner's Relationship Questionnaire

Dr. Brawner's Relationship Questionnaire

  • MM slash DD slash YYYY
  • What's the current status of your relationship?

    Please tell me a little bit about the CURRENT status of your relationship by answering the questions below.
  • About your relationship.

    Please answer the following with a "yes" or "no" as best describes your current situation.
  • This field is for validation purposes and should be left unchanged.