Candlelight Christian Fellowship Marriage Pre-Counseling ...

[Pages:11]Candlelight Christian Fellowship Marriage Pre-Counseling Questionnaire (Husband)

Name:___________________________________________Date:_____________ Married?_________ If yes, name of spouse: _____________________________ If married, how long? ________________________________________________ Is this your first marriage? ____________________________________________ Do you have children: ____________ If yes, how many? ___________________ Are you a believer? __________________________________________________ Is your spouse a believer? ____________________________________________ Current address: __________________________________________________________________ __________________________________________________________________ Phone number (s): __________________________________________________ Are you a member of Candlelight? _____________________________________ If not: Are you a regular Church Attendee? ____________________________________ If Yes, where do you attend? __________________________________________ May we contact your pastor? __________________________________________ Phone number: (____) _______________________________________________ Please list two personal references. Name: ____________________________________Phone#_________________ Relationship: Friend_____________ Family_____________ Other____________ Name: ____________________________________Phone#__________________ Relationship: Friend_____________ Family_____________ Other____________

Husbands Only! (Continued)

Are you having marriage trouble? ______________________________________

If yes, please explain the problem as you see it. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Please state what you believe led up to this current situation: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________

Husbands Only! (Continued)

Are you willing to do whatever the Lord calls you to do in order to bring restoration and healing to your marriage?________________________________

Do you believe the Bible is the final authority? ___________________________

Are you willing to submit to Biblical counsel? _____________________________

Any additional Comments you would like to share?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _____________________________________________________________

What do you feel will be the solution to your difficulty?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Have you made every effort to do your part to accomplish the above? _________

If so, what do you believe was the cause of the issue going unresolved?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Husbands Only! (Continued)

Please read the following:

Ephesians 5:25-32 "Husbands, love your wives, just as Christ also loved the church and gave Himself for her, that He might sanctify and cleanse her with the washing of water by the word, that He might present her to Himself a glorious church, not having spot or wrinkle or any such thing, but that she should be holy and without blemish. So husbands ought to love their own wives as their own bodies; he who loves his wife loves himself. For no one ever hated his own flesh, but nourishes and cherishes it, just as the Lord does the church. For we are members of His body, of His flesh and of His bones. `For this reason a man shall leave his father and mother and be joined to his wife, and the two shall become one flesh.' This is a great mystery, but I speak concerning Christ and the church."

Colossians 3:19 "Husbands, love your wives and do not be bitter toward them."

1 Peter 3:7 "Husbands, likewise, dwell with them with understanding, giving honor to the wife, as to the weaker vessel, and as being heirs together of the grace of life, that your prayers may not be hindered."

Wedding Vows (For review)

It is the duty of the husband to provide for and support his wife, to shelter her from danger, and to cherish her with unending affection.

With this in mind:

Do you take ________ to be your lawfully wedded wife, to live together with her in accordance to God's Word, to have and to hold, for better and for worse, for richer and for poorer, in sickness and in health.

Do you promise to love her, provide for and cherish her, giving honor unto her and keeping yourself only unto her for as long as you both shall live?

And...

I, _______ take you, _________ to be my lawfully wedded wife, my constant friend, my faithful help mate, and my love, from this day forward. In the presence of God, our family and friends, I offer to you my vow, to be your faithful husband, in sickness and in health, in good times and in bad, in joy as well as in sorrow. I promise to love you unconditionally, to support you, to honor you, to laugh with you, cry with you, and to cherish you, for as long as we both shall live.

All that I am and all that I possess are yours. It is my desire to love you unreservedly in all I say and do.

Husbands Only! (Continued)

Do you believe you love your wife like Christ loves the Church? ______________

Do you believe it is you responsibility to serve your wife and nurture her like Christ does the Church? ______________________________________________

Are you bitter toward your wife? _______________________________________

Do you expect your wife to be any more that she is designed to be? ___________

Do you listen to your wife when she shares her heart with you? ______________

Comments:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

WAIVER OF LIABILITY

I, ______________________hereby release Candlelight Christian Fellowship from any and all liability connected with my participation in church counseling. I acknowledge that I am participating in these activities on my own time and of my own free choice. I hold Candlelight Christian Fellowship and its pastoral staff harmless for all liabilities sustained while in counseling and or related to any choices I make to comply with counsel given.

_________________________ Signature

___________________________ Printed Name

_________________________ Date

Candlelight Christian Fellowship Marriage Pre-Counseling Questionnaire (Wife)

Name:___________________________________________Date:_____________ Married?_________ If yes, name of spouse: _____________________________ If married, how long? ________________________________________________ Is this your first marriage? ____________________________________________ Do you have children: ____________ If yes, how many? ___________________ Are you a believer? __________________________________________________ Is your spouse a believer? ____________________________________________ Current address: __________________________________________________________________ __________________________________________________________________ Phone number (s): __________________________________________________ Are you a member of Candlelight? _____________________________________ If not: Are you a regular Church Attendee? ____________________________________ If Yes, where do you attend? __________________________________________ May we contact your pastor? __________________________________________ Phone number: (____) _______________________________________________ Please list two personal references. Name: ____________________________________Phone#_________________ Relationship: Friend_____________ Family_____________ Other____________ Name: ____________________________________Phone#__________________ Relationship: Friend_____________ Family_____________ Other____________

Wives Only!

Are you having marriage trouble? ______________________________________

If yes, please explain the problem as you see it. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Please state what you believe led up to this current situation: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Wives Only! (Continued)

Are you willing to do whatever the Lord calls you to do in order to bring restoration and healing to your marriage?________________________________

Do you believe the Bible is the final authority? ___________________________

Are you willing to submit to Biblical counsel? _____________________________

Any additional Comments you would like to share?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

What do you feel will be the solution to your difficulty?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Have you made every effort to do your part to accomplish the above? _________

If so, what do you believe was the cause of the issue going unresolved?

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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