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Rebuilding a Healthy Foundation

Take your time in completing this questionnaire.

Press start when you're ready.

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This questionnaire should be answered with 100% honesty and transparency.
1

What do you think ended the relationship?

2

Besides what actually happened, what other reasons do you think would have eventually ended the relationship?

3

How much do you trust your partner?

On a scale of 1 to 10
4

If you were your partner, how much would you trust yourself?

On a scale of 1 to 10
5

How did your partner break your trust?

6

How did your partner hurt you?

7

Do you think this is something that your partner would do to you again?

Intentionally or unintentionally
8

What do you think hurt your partner?

9

Do you think this is something that you might do to your partner again?

Intentionally or unintentionally
10

Are you still hurt?

Questions 10-12 are only for you, sharing your answers is your choice
11

If yes, do you think you can ever move on from that?

12

If yes, how do you think you can move on?

If you cannot move on, then there is no need in completing the questionnaire. Your mental health is more important than getting back together.
13

How would you handle these situations if they ever came up?

Return to questions 7 and 9
14

If the same reason that first ended the relationship reoccurred, what would you do differently when handling the situation?

15

What do you think your partner should do in order to gain back your trust?

16

What do you think you should do in order to gain back your partner's trust?

17

If you can change one thing about your partner's behavior in the relationship, what would it be?

Something that is controllable
18

Do you trust your partner enough to give them another chance?

A chance to gain back your trust
19

Should your partner trust you enough to give you another chance?

A chance to gain back their trust
20

Do you agree with your partner's answers?

Answer together after discussion

After completing this part of the questionnaire, discuss each question with an open mind, empathy, and listen to your partner's perspective on the issue.

For question 20, if either you or your partner answered no then you are not on the same page.

If both you and your partner answered yes, then you may proceed with building a healthy foundation for your relationship based on honesty and working on your trust.

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This questionnaire should be answered with 100% honesty and transparency.

Regaining respect in a relationship can be difficult, but taking responsibility for your own actions is a step in regaining your partner's respect. Openly communicating with your partner about what behaviors you consider disrespectful for you, may help your partner in regaining your respect.

21

Define 'respect' in your own words

22

Do you think what you described as 'respect' was present in your relationship?

23

How much do you think your partner respects you?

On a scale of 1 to 10
24

How did you feel disrespected by your partner?

25

How much do you respect your partner?

On a scale of 1 to 10
26

How did your own lack of respect reflect on your behavior towards your partner?

27

What do you like and respect about your partner?

Give 3 or more traits
28

What are your boundaries?

29

List behaviors that your partner should do or stop doing

Specify whether negotiable or non-negotiable
30

How would you show your partner respect?

You can add to the list with your partner during discussion

Your responses are private until you're ready to discuss them with your partner

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