VR Coaching for Couples: Assessment

VIVID Relationships: Couples Assessment

Please complete this assessment together as a couple. Choose one response for each question that reflects your shared experience. If you disagree, discuss it and select the response that feels most accurate for both of you.

During Session 1, your provider will review each response with you and help explore any areas where your views differ significantly.

Email *

Partner A *

Partner B *

How Long Have You Been A Couple? *

What is your Current Relationship Status? (Choose all that apply) *

Living Together Living Separately Married Unmarried Separated Divorced From Each Other Other

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Pillar: Communication *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

🤝

Pillar: Trust *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

❤️

Pillar: Intimacy *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

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Pillar: Fun *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

When do you feel most connected to your partner? *

Which 2 do you believe are your biggest challenges as a couple? *

Communication Trust Intimacy Fun

What would a "successful" relationship look like to you in 6 months? *

Feel free to share anything else you think your Provider should know about your relationship.

Your responses are private and will only be reviewed by your VIVID provider.

✓

Assessment Received

Thank you for completing the VIVID Relationships Couples Assessment. Your provider will review your responses before your first session and use them to guide your work together.

With care,

DR.VIVIANA™

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