Uncommon Therapy
Uncommon Therapy

Relationship Check-Up Form

Use this form to take a quick look at the health of your relationship(s).


Pick a topic area, such as: sex/physical touch, finances, parenting, interacting with friends, vacations, time alone, etc.  Make the topic as big or as small as you like.  Then simply answer the questions as best as you can.


Relationships get into habits -- things we started doing because they were the best choice at the time become the things we just keep on doing without thinking, even if changes in our circumstances no longer make this the best choice.  Taking a few moments to think about things can help keep these habits from changing (or losing) the meaning you wanted for this area you share.


Looking at this also opens the door up to looking at the forms being used in this area and identifying if they mean the same thing to you as they do to the other person or entity.  When you know the meanings, it's easier to adjust or replace the form to end up with something better.


The form is downloadable through the following link.  It is in Microsoft Word format.

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

relationship check-up form v1 04-09-1[...]
Microsoft Word document [96.0 KB]

Larry Moen, LPC

Where to Find Me

Uncommon Therapy

565 University Avenue

Fairbanks, AK 99701 



(907) 459-8200

Office: (907) 374-8777

Text: (907) 388-8963

(best method)

Email: uncommon.alaska@gmail.com



Or use our contact form.

Office Hours

Monday - Friday 9 AM - 6 PM

Saturday and other hours by arrangement


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