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Personal Information

Marriage Intensive Readiness & Safety Screening

Is your spouse willing to participate in the intensive?*
How would you best describe your marriage at this time? (Please select the option that fits best.)
Which of the following are currently present in your marriage? (Check all that apply.) Required
In moments of conflict, how do disagreements typically end? Required

Completion of this form does not guarantee acceptance into the marriage intensive. Each submission is prayerfully and clinically reviewed to ensure readiness, safety, and fit. Some couples may be better served through individual counseling or additional support prior to participating in an intensive.

Thanks for submitting!

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