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Home Christian Church’s

Spiritual Marital Counseling Questionnaire

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Marriage is a sacred covenant before God, and understanding the spiritual, emotional, and relational state of your household is essential for effective counseling. This form serves as a prayerful reflection of your marriage, allowing me to discern the nature of your struggles, strengths, and the areas where healing and restoration are needed.

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Honest and complete responses are vital, as they provide a foundation for biblical guidance, accountability, and transformation. Just as Proverbs 27:23 reminds us, "Be thou diligent to know the state of thy flocks, and look well to thy herds," this form helps us look carefully at the state of your marriage with clarity and truth.

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To ensure prayerful preparation and discernment, this form must be completed at least 48 hours before your first scheduled counseling session. Your commitment to this process reflects your desire to allow God to move, heal, and restore your union according to His divine plan.

Birthday
Month
Day
Year
Have you tried marital counseling in the past?
In your house, is the husband the head of the household?

This is the RAPID FIRE QUESTION SECTION: Check your answers to the questions quickly and without giving much thought, this will allow your heart to answer rather than your head!

Does your wife/husband respect you?
Yes
No
Have you been unfaithful in your marriage?
Yes
No
Do you trust your spouse with your heart?
Yes
No
Would you describe your wife as a woman of virtue, displaying godly character?
Yes
No
NA
Would you define your husband as a Godly man?
Yes
No
NA
Was counseling a mutual decision (As opposed to you feeling forced into it)?
Yes
No, I feel Forced
Does your wife/husband care for you whole heartedly and tenderly?
Yes
No
NA
Do you feel like your wife/husband really knows who you are- or is their opinion skewed?
Yes
No
Outside of the marital issues, does your LIFE fulfill your hearts desires (or is there something that you are missing)?
Yes
No, There is something missing!
Outside of the marital issues, are you PERSONALLY where you believe you should be in life (career, education, accomplishments?
Yes
No
SPIRITUALLY, are you where GOD says you should be (personal relationship with God, worship, personal bible study and intimacy with the Spirit)?
Yes
No
Do you emotionally abuse your husband/wife?
Yes
No
Do you physically abuse your husband/wife?
Yes
No
Is your communication style volatile (screaming, throwing things, slamming doors, stumping around?
Yes
No
Knowing what you know about your husband/wife, would you marry him/her again?
Yes
No
Are you the MOST important person to your husband/wife?
Yes
No
Do you feel supported, valued, and appreciated by your wife/husband?
Yes
No
Do you feel heard and understood by your wife/husband?
Yes
No
Sometimes
It's rare
Are you in love with your husband/wife?
Yes
No, but I want to get back there!
I'm not sure
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