Initial Consultation Form

Start your journey with a one-on-one consultation to explore how premarital counseling can support a healthy, lasting relationship.

Take The First Step

Clarity, Connection, and Commitment Begin Here

This questionnaire must be filled out completely.

After being reviewed, an appointment will be made to meet with the counselor. A determination will be made whether or not to begin the pre-marriage counseling after this meeting.

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

Both you and your fiancé need to complete a questionnaire.

Initial Consultation Fee: $160/person

General Information

Have you set a tentative date for your wedding? *YesNo

What is the wedding date? *

Personal Information

First Name *

Last Name *

Age *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Mobile Phone *

Fiancé’s First Name *

Fiancé’s Last Name *

Fiancé’s Age *

Engagement Period

How long have you known each other? *(i.e. 5 months, 5 years, etc.)

How long have you been dating? *(i.e. 5 months, 5 years, etc.)

How long have you been engaged? *(i.e. 5 months, 5 years, etc.)

Marital Status

Have you been previously married? *YesNo

How many times have you been married? *

How long were you married? *

Are you: *Divorced?Widowed?Separated?N/A

Is your divorce final? *YesNo

When will your divorce be final? *

Children

Do you have children from a previous relationship/marriage? *YesNo

How many children do you have? *

What are their ages? *

Religious Background

Are you a Christian? *YesNo

What religion do you practice?

Support Systems

Do you have people that you can turn to for support? *YesNo

Please provide the name of each person in your support system and their relationship to you *

Presenting Issues

Briefly explain what concern(s) that you would like to address during premarital counseling. *

What do you hope to achieve or accomplish through premarital counseling? *

Please describe what you believe your fiancé’s specific goals for counseling. *

What concerns do you hope to resolve by the time you get married? *

Please answer the following questions as completely as possible. Remember that our goal is to help you prepare for marriage. Therefore be honest with your responses. Don’t simply write the answers you think we expect.

Describe what attracted you to your fiancé. *

How did you get along with your father and mother during your childhood? *

Describe your present relationship with your father and mother. *

What practices in your home were very different from those in your fiancés home? *

Relationship Questions

Briefly describe your family. *

What are any current expectations your family of origin has of you? (financial, emotional, etc.) *

What are your needs for physical affection? *

Is there any hesitancy in sharing your thoughts about sex with your fiancé? Describe *

Please describe in detail any areas of your relationship that may or have already caused problems between the two of you. Have you been able to work on a resolution together? *

Promo CodeEnter a promo code for discounted consultation fee

Date

Message Us

Contact Us Today

Your future together begins with a single step. Contact us today to schedule a consultation and let’s start building the marriage you envision.

Call Us

(469) 744-6975

First Name *

Last Name *

Email Address *

Phone Number

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Open Hours

M-F: 10am – 7pm, Sa: 9am – 1pm

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Email

info@david-page.com