Marriage Counseling

Form

Name

Telephone

Age

Gender

Name of Spouse

Mailing Address

State

City

ZIP

What religion do you belong to?

What religion does your spouse belong to?

Have you been married before?

Have you attended pre-marital counseling?

If you have attended pre-marital counseling, where?

For how long were you counseled?

Do you have any children?

If yes, how many?

How long have you known eachother?

When would you like to start counseling?

Why would you like to get married?