Value Your Marriage

Value Your Marriage

Premarital Counseling Intake Form
Please complete this form together before your first session. Your response help us serve you with clarity, care, and wisdom. Thank you.
What type of coaching are you seeking? (select one)*

Premarital CoachingMarital CoachingFinancial Coaching
Name (Husband or Fiancé)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Age*
Occupation*
Name (Wife or Fiancée)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Age*
Occupation*
What city and state do both of you live in?
Spiritually, where would you place your relationship as a couple?

We are both committed ChristiansOne of us is committed, one is unsureWe both believe in God but aren't active spirituallyWe have different beliefsPrefer not to answer
Are you currently connected to a local church?

Yes, we attend regularlyYes, but not consistentlyNot at this timeWe are looking for a church
Church Name (Optional)
Which of the following describes your family situation?

We have children togetherOne of us has children from a previous relationshipBoth of us have children from previous relationshipsWe currently have no childrenPrefer not to answer
Do you believe that God brought you together as a couple?

Yes, absolutelyWe're not sure yetWe don't believe God brought us togetherOur answes differPrefer not to answer
Thank you for taking the time to complete this form.

Your responses will help us understand your needs and prepare for your first session.

Click Submit when you're ready.
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