Pre-Marital Questionnaire Form

Pre-Marital Questionnaire Form
This questionnaire should be filled out completely and turned in to the office. After being reviewed, an appointment will be made to meet with a counselor, at this time we will determine whether to begin the pre-marriage counseling.

NOTE: We reserve the right to discontinue the counseling and planning process at any time, at our discretion.

*****Both you and your fiancé can complete a questionnaire separately or together, however both must be present for the actual Pre-Marital counseling with the Counselor.
General Information:
Have you set a tentative date for your wedding?

YesNo
If yes, when?
Personal Information:
Name
Age
Address
Home Phone
Work Phone
Fiancé’s Name
Age
Marital Status:
Have you been married before?

YesNo
If yes, how many times?
If so, for how long?
Are you:

DivorcedWidowedSeparated
Is your divorce final?
If not, why & when?
Do you have children from a previous marriage?

YesNo
If yes, how many?
What are their ages?
If you are divorced, what is your custody arrangement?
If divorced, why was your previous marriage terminated?
Engagement Period:
How long have you known each other?
How long have you been going together?
How long have you been officially engaged?
(We require that you have been dating seriously for at least eight months before we will begin counseling)
What brought you together?
Religious Background:
Are you a Born-Again Christian?

YesNo
Briefly describe what it means to be Born Again:
Do you regularly attend a church?

YesNo
If yes, which one?
For how long and how often?
Please answer the following questions as completely yet as briefly as possible. Remember that our goal is to help you prepare for marriage. Please be honest with your responses. Don’t simply write the answers you think we expect.
1. Write a definition of “Love”.
2. How do you know you “love” your fiancé?
3. How have you prepared for marriage?
Have you read any books?

YesNo
If so, please list them.
Have you listened to sermons on marriage?

YesNo
If so, please list them.
Have you attended any marriage classes?

YesNo
If so, please describe them.
Have your parents ever been divorced or remarried? Yes No

YesNo
If so, why?
4. What do you expect to receive from marriage that you cannot have staying single?
5. Give some reasons why you want to marry your fiancé.
6. List any concerns about marrying your fiancé.
7. What do you see as your role in the marriage?
8. What do you see as your mate’s role in the marriage?
9. With so many marriages failing today, what guarantee do you have that your marriage will remain successful?
10. How do other members of your family feel about your fiancé?
11. How do you feel you are accepted by your fiancé’s family?
12. How will you handle conflict or disagreements?
13. Do you plan on having children? If so, how many?
14. Who will discipline your children and how?
15. Who will handle your finances? If there are differences, how will you handle them?
16. Thoughts and plans for emergency funds? (if appliance repair or emergencies arise)
17. Creating a special time for dating. What plan do you have?
18. What plans do you have to keep your marriage fresh and alive?
19. Sports, TV, shopping and other boundaries and limitations you can be agreed on?
20. Priorities on purchasing items other than using credit cards?
Please Note:

It is understood that entering into premarital counseling is NOT an agreement of approval to be married by a Counselor or anyone else at our office. Our counsel is based solely on God’s Word. Be sure you thoroughly understand our position, before signing below:

I acknowledge that I have read and understand the above, and that all of the information filled in is true and correct to the best of my knowledge.
Signature of future husband

Clear
Date

MonthDayYear
Date
Signature of future wife

Clear
Date

MonthDayYear
Date
Should be Empty:

Pre-Marital Questionnaire Form

General Information:

Personal Information:

Marital Status:

Engagement Period:

Religious Background: