Think about your current (or past) relationships and answer the following questions with them in mind. Simply agree or disagree with the statements below. There are no wrong answers or better answers. These questions are designed to help you better understand your relationship style and we are here to help talk through them with you.

First up, let’s answer some simple questions so we can get you lined up to chat with one of our therapists FOR FREE, to review your results.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

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Age *

Are you (or the person you are seeking help for) age 18 or over?

Yes, I/we am/are age 18 or older

No (The Keely Group is only able to work with adults ages 18+)

Location *

Which state do you live in?

New York

New Jersey

Pennsylvania

International

Somewhere else (The Keely Group is able to provide services to anyone living in NY, NJ, PA or outside of the USA)

How did you hear about us? *

Personal Referral

Physician/Medical Professional

Google

Psychology Today

Instagram

Facebook

YouTube

TikTok

Yelp

Other

Now, Let's Get to the Questionnaire

I often worry that my partner will stop loving me *

Agree

Disagree

I worry that I feel more strongly about my partner than they do about me *

Agree

Disagree

I can feel somewhat anxious and incomplete when I am not in a relationship

Agree

Disagree

I’m satisfied with my current relationship but, I find myself wondering if there is better match for me *

Agree

Disagree

I find that I often self-sabotage when I feel like my relationship is getting more serious *

Agree

Disagree

I find it difficult to be away from my partner and worry that they may lose interest in me. *

Agree

Disagree

I feel comfortable expressing my needs and opinions even if it means we disagree . *

Agree

Disagree

When I notice a change in my partner’s mood, I wonder what’s happened, but I’ll know it’s likely not about me. *

Agree

Disagree

I feel comfortable relying on my partner for support. *

Agree

Disagree

I find it easy to express affection in a relationship. *

Agree

Disagree

I value my independence more than my relationships. *

Agree

Disagree

When I am with my partner I often feel the need to escape, but then I miss them when we’re apart. *

Agree

Disagree

Phew! You Did Great. Now, let's get you connected with one of our expert virtual therapists to help you better understand your personal attachment style.

Scheduling Preference *

Which of the following best matches your availability for a complimentary 20-minute phone consult?

Weekday Morning

Weekday Afternoon

Mon-Thurs Evening

Weekend Morning

Weekend Afternoon

Anything else you'd like us to know or any specific questions we can answer for you?

Thank you! You are one step closer to better understanding your own unique attachment style.

Someone from our team will be in touch to set up a FREE consult. We look forward to discussing the results with you!