User Log On

Dr Kelsey Graham, Wedding Officiant Dr Kelsey Graham, Wedding Officiant

Premarital Counseling Survey Premarital Counseling Survey

This post has been viewed 601 times.

Printable Version
Email to a Friend
Subscribe: Email, RSS

Premarital Counseling Survey

Posted on Wed, Oct 31, 2012

 

Premarital Counseling Survey 
 
Though I do not require pre-marriage counseling I make it available for those who may desire it. Should you desire counseling please copy and paste the below into a word doc, print out two copies and both of you fill out the qustionare individually without discussing or sharing. 
 
This survey is designed to help the counselor understand who you are, where you’re at in your 
current relationship, and how you view love and marriage. You may find some of the questions 
a bit threatening. Please be assured that your answers will be held in strict confidence and will be 
used to help you establish a solid foundation for your marriage. The survey will only be useful 
to the extent that you answer the questions honestly and thoughtfully. Please answer the 
questions by yourself, without discussing your answers with your partner. 
 
Date:___________________ 
 
Name:___________________________________ 
 
Address:_________________________________ Phone:_______________________________ 
 
Email:___________________________________Cell Phone: ___________________________ 
 
Sex: Male_____ Female_____ Age:_____ 
 
High school graduate? Yes No College degree? Yes No Major _____________ 
 
Graduate degree(s)? Yes No Field of study___________________ 
Current job/career:_______________________________________________
_______________ 
Career goals:___________________________________________________________________ 
 
When did you first start dating each other? ___________________________________________
 
When did you become engaged?___________________________________________________ 
 
Have you ever called off your engagement? Yes No 
 
 
When do you plan to be married?________________________ 
Using a scale of 1 = uncertain, 10 = completely certain, how certain are you that your fiancé is 
you best choice for your life-partner? 
 
1 2 3 4 5 6 7 8 9 10 
 
SPIRITUAL HISTORY: 
 
Were you raised in a religious family? Yes No 
 
As a child, did your family attend services:
 
_____Not at all _____Less than once a month 
 
_____About once a month _____Usually every week
 
What was your father’s religious faith?________________________ 
 
How strong was his faith? _____Very _____Moderate _____Not very 
 
What was your mother’s religious faith?________________________ 
 
How strong was her faith? _____Very _____Moderate _____Not very 
 
How important are spiritual things to you? _____Very _____Moderately _____Not very
 
In a normal week, how mmuch time do you spend fucused on your beliefs?__________________
 
In your opinion, how important are spiritual things to your fiancé? _____Very _____Moderately _____Not very 
 
How closely do the two of you agree on spiritual/ belief matters? 
 
___Very much ___Generally ___Not very much ___Don’t know (haven’t discussed it) 
 
What changes (if any) would you like to make in your own spiritual life?_________________________ 
 
What changes would you like (if any) your partner to make in his/her spiritual life?_________________ 
 
Have you come to a place in your spiritual life journey where you can say for certain that comfortable with those beliefs? _____Yes _____Not sure _____No 
 
 
FAMILY BACKGROUND: 
 
Were your parents ever: _____Divorced _____Separated _____Widowed 
 
If so, how old were you?_________________ 
 
Please list all brothers and sisters (first names) and their current ages. 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
How would you rate your parents’ marriage? (Circle one) 
 
*Very happy *Usually happy *Troubled at times *Very troubled 
 
What were your parents’ occupations? 
 
Father __________________________________ Mother _____________________________
 
How would you rate your childhood? (Circle one) 
 
*Very happy *Usually happy *Troubled at times *Very troubled 
 
How old were you when you left home permanently, or do you still live at home?
 
How do your parents view your proposed marriage and fiancé? 
 
_____Very positive _____Generally positive _____Hesitant _____Opposed 
 
If opposed, briefly explain; _______________________________________________________ 
 
______________________________________________________________________________
 
PAST MARITAL HISTORY: 
 
If you have never been married, lived with a person of the opposite sex as if you were married, 
or widowed, please go on to the next section. If any of the above apply to you, please answer 
each of the following questions as it pertains to your situation. 
 
For each marriage or living arrangement with a person of the opposite sex, please list your age 
and your partner’s age when the marriage or living arrangement began, and how long it lasted. 
Please indicate the type of arrangement and how it ended. For example, “Marriage, I was 21, my 
partner was 20, 4 years, divorce.” 
 
Did you have (or are you expecting) any children by any of these relationships? If so, give their 
sex and year of birth. Circle any who are now living with you. 
 
 
In your opinion, what were the major factors which led to the breakup of these relationships? 
(Use other side if needed.)
 
HISTORY OF YOUR PRESENT RELATIONSHIP: 
 
List five specific qualities in your partner which attracted you to him/her.
 
1._______________________2._________________________ 3._________________________ 
 
4._______________________5._________________________ 
Realizing that no one is perfect, list five things about your partner which you view as 
weaknesses. 
1._______________________2._________________________ 3._________________________ 
 
 
 
If you could change your partner in one way, what would it be? 
 
If you could change yourself in one way, what would it be? 
 
What are the three things you and your partner most enjoy doing together? 
 
1._______________________2._________________________ 3._________________________ 4._____________________________
 
5._________________ 
 
Realizing that every couple in love wishes to express their feelings, please answer the following: 
 
 
1. We see each other: Daily ___ 5-6 days/week ___ 3-4 days/week ____ 1-2 days/week ____ 
 
Less than once/week ____ 
 
 
2. We kiss each other: Often ___ Once or twice when we’re together ____ 
 
Rarely ____ Never ____ 
 
 
3. We sexually touch each other: Often ___ Occasionally ____ Rarely ____ Never ____
 
 
4. We have sexual intercourse: Often ___ Occasionally ____ Rarely ____ Never ____ 
 
 
5. How do you feel about your level of physical involvement? 
 
Good ____ Concerned ____ Guilty ____ Trapped _____
 
 
CONCEPTS THAT WILL AFFECT YOUR MARRIAGE: 
 
 
Please give a one sentence definition of love:_________________________________________ 
 
 
Please give a one sentence definition of marriage:______________________________________ 
 
What fears do you have about marriage?_____________________________________________ 
 
 
List 3-5 factors you think are most important in a successful marriage:_____________________ 
 
Who and/or what has most influenced your attitudes toward marriage?_____________________ 
 
What problems, if any, need to be overcome before you feel completely comfortable about 
marrying? 
 
What specific areas are you most interested in discussing during premarital counseling?
 
The premarital counseling program involves a commitment on your part to attend all the sessions 
and to complete all the assignments as conscientiously as possible. Are you willing to make 
such a commitment? 
 
____ Yes ____No
 
 

   Discussion: Premarital Counseling Survey

No messages have been posted.

You must first create an account to post.