Premarital Counseling Questionnaire

As you answer these questions, please understand that this is a standard form that we ask all couples engaged in the Premarital Counseling process to fill out. Since each couple is at varying levels of familiarity with church leadership, this form represents a helpful tool to collect information that will benefit both the couple and the counselor as the process moves forward.

1Family History > 2Financial History > 3Health History > 4Sexual History
Name Name First Last
Family History
Are your parents still married to each other?

Are your parents still married to each other? Yes No
If not, please explain why.
Did they ever get remarried?
What was/is your relationship with their new spouse(s)?
Did you ever live with anyone other than your parents growing up?

Did you ever live with anyone other than your parents growing up? Yes No
Are you currently living with your fiancée/fiancé?

Are you currently living with your fiancée/fiancé? Yes No
Have you been previously engaged?

Have you been previously engaged? Yes No
How many times?
Please briefly explain the circumstances that ended the relationship(s).
Have you been previously married?

Have you been previously married? Yes No
How many times?
Please briefly explain the circumstances that ended the relationship(s).
Do you have children from a previous relationship?

Do you have children from a previous relationship? Yes No
Please list their names and ages.
What is your legal responsibility for them (financial, visitation, etc.)?
Is there abuse (physical, verbal, sexual, etc.) in your past?

Is there abuse (physical, verbal, sexual, etc.) in your past? Yes No
Please list the type of abuse and from whom it came.
Did you receive counseling/help?

Did you receive counseling/help? Yes No

Premarital Counseling Questionnaire

Premarital Counseling Questionnaire

Family History