Premarital Counseling PDI

Please take the next 30 minutes or so to complete this inventory.

By completing this, it gives your counselor good preliminary information in order to get a “running start” in the early sessions.

The heart of nouthetic counseling is in the fundamental belief that the Bible is completely sufficient to meet all of life’s most difficult circumstances. Thus, our counseling keeps the Bible at the forefront of everything we teach and counsel.

Although our counseling is free, we have four primary requirements for counseling. If you can agree to these, please complete the form below.

You must be teachable
You must be honest
You must do your homework
If able, you must attend Community Bible Church during the time you are being counseled (it is not a requirement to give or serve)

If you have any questions about our counseling ministry, call (352) 229-2060. Our secretary works as a volunteer so if she cannot answer the phone, please leave a message and your call will be returned as quickly as possible.

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Occupation*

Employer*

Sex*

MaleFemale

Birthdate*

Age*

Highest Level of Education*

Degree

Other Training (List type and years)

Hobbies*

Referred to us by*

Denomination Preference*

Are you a member?*

YesNo

Church attendance per month*

Do you consider yourself a religious person?*

YesNoSomewhat

Do you believe in God?*

YesNoUnsure

How often do you pray to God?*

OftenOccassionallyNever

Are you saved?*

YesNoUnsure

If saved, briefly describe how someone gets saved:

How often do you read the bible?*

OftenOccassionallyNever

Do you have regular devotions?*

YesNo

Explain recent changes in your religious life, if any:

Have you ever been married?*

YesNo

If yes, what is your current status?

Please list all children (if any):

If you were reared by anyone other than your parents, briefly explain:

How many older siblings do you have?*

How many younger siblings do you have?*

How did you meet?*

How long have you known each other?*

How long have you been dating?*

Why did you decide to get married?*

When do you plan to get married?*

Why do you want to have Pre-Marriage counseling?*

What is your idea of a Christian marriage?*

What is your biblical role in marriage?*

How do your friends and family feel about your engagement?*

Have any expressed concerns? If so, what are they?*

Describe the spiritual aspect of your relationship up to this time:*

How would you like your spiritual relationship to improve?*

Describe both the strengths and weaknesses of your mate:*

What potential problems do you anticipate in your marriage?*

What role will your parents have in your marriage?*

Are you living together currrently?*

YesNo

If yes, are you willing to move to separate households until you are married?*

YesNo

Are you sexually actively?*

YesNo

Are you willing to completely abstain until you are married?*

YesNo

Consent to Counsel

The Life Center, A Ministry of Community Bible Church

Ocala, Florida

Our Goal:
Our goal in providing biblical counseling is to help you meet the challenges of life in a way that will please and honor the Lord Jesus Christ and allow you to enjoy fully His love for you and His plans for your life.

Biblical Basis:
We believe that the Bible provides sufficient guidance and instruction for faith and life. Therefore, our counseling is based on scriptural principles rather than those of psychology or psychiatry. Neither the pastoral, nor the lay counselors of this ministry are licensed as psychotherapists or mental health professionals and may or may not have degrees or certifications. All our counselors are under the authority of the elders of Community Bible Church.

Professional Advice:
In the process of biblical counseling there are often times when there is a need for significant advice with regards to legal, medical, financial or other technical areas. In those cases you will be encouraged to seek independent professional counsel. Our pastoral and lay counselors will be happy to cooperate with such advisors and help you consider their counsel in the light of relevant scriptural
principles. Some of our lay counselors may be lawyers, doctors or other professionals, but the counselee understands and agrees that such counselors are not providing advice in those areas during the counseling process.

Fees and Resources:
We want to bless our community by providing these counseling services. Since the counselors volunteer their time, we can offer the counseling free of charge. In order to provide good, helpful resources, we ask, if you are able, to pay for the reading materials you will need (usually around $15/resource). Out of respect for our staff we require a $25 deposit that will be refunded to you should you keep all your appointments or cancel at least 24 hours in advance of your appointment. When you arrive for your first counseling session you will be required to submit this deposit in cash. If you should ever cancel upon less than 24 hours notice, you would forfeit your cancellation fee. You would need to submit another $25.00 before continuing your counseling sessions.

What to Bring:
Please bring with you (one for each person being counseled) a Bible (a literal translation such as NASB, ESV, NIV etc. rather than a paraphrase such as The Living Bible), loose-leaf notebook, paper and pen.

Training Center:
The Life Center, A Ministry of Community Bible Church is also a training center for future counselors. Accordingly, to facilitate both counseling and training, the counselor may have one to two people assisting or observing him/her in each counseling session.

Confidentiality:
Confidentiality is an important aspect of counseling, and we will carefully guard the information you entrust to us. There are situations, however, when it may be necessary for us to share certain information with others. Therefore, you agree that our counselors may share certain information:

1) When a counselor is uncertain how to address a particular problem and needs to seek advice from another pastor, elder or counselor;
2) When a counselee attends another church, and it is necessary to talk with his or her pastor or elders;
3) When there is a clear indication that someone, including you, may be harmed unless others intervene;
4) When required by laws of the State of Florida and the United States of America;
5) When a person persistently refuses to renounce a particular sin, and it becomes necessary to seek assistance of others in the church to encourage repentance and reconciliation (see Matt 18:15-20; Prov 15:22; 24:11).

Also, if you are a member/attender of Community Bible Church, the fact you are receiving counseling may be shared with the Pastor-Teacher to assist him in shepherding the flock.

Be assured that our counselors strongly prefer not to disclose personal information to others, and will make every effort to help you find ways to resolve a problem as privately as possible.

Resolution of Conflicts:
On rare occasions a conflict may develop between a counselor and a counselee. In order to make sure that any such conflicts will be resolved in a biblically faithful manner, we require all of our counselees to agree that any dispute that arises with a counselor or with the church as a result of counseling, will be settled by mediation and, if necessary, legally binding arbitration in accordance
with the Rules of Procedure of the Institute for Christian Conciliation, a division of Peacemaker® Ministries (complete text of the Rules is available at www.Peacemaker.net). Judgment upon arbitration award may be entered in any court having jurisdiction.

The parties understand that these methods shall be the sole remedy for any controversy or claim arising out of this agreement and expressly waive their right to file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitration decision.

An executed facsimile copy or e-mail delivery of a “.pdf” format data file shall be an acceptable form of acceptance of this Consent.

If you have any questions about these guidelines, please talk with Mike DeGuzman, Teaching Pastor of Community Bible Church (352) 680-0056.

I/WE HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS, AND I/WE UNDERSTAND THEM AND I/WE HEREBY ACKNOWLEDGE AND AGREE TO ALL OF THE ABOVE TERMS, INCLUDING, BUT NOT LIMITED TO, THE CANCELLATION POLICY, WAIVER OF SEEKING REDRESS (LAWSUIT) IN THE CIVIL COURT SYSTEMS, AND AGREEING THAT ANY AND ALL DISPUTES BE RESOLVED THROUGH RESOLUTION AS DETAILED ABOVE.

Signature*

Pre-Marital Counseling