PIF Adult 2 Marriage and Family Information Name of Spouse Cell Phone # Age Birth Date Occupation Education Elementary High School GED College Graduate / Seminary Degrees Other Training (Please list type and years) Does your spouse know you are coming for counseling? Yes No Is your spouse willing to come for counseling? Yes No Uncertain Have you ever been separated Yes No When? From: Until: Your ages when married: Husband: Wife: Years married: How long did you know your spouse before marriage? Length of steady dating before marriage: Length of engagement: How often do you spend meaningful time with your spouse? Not often Occasionally Regularly If applicable, please give brief information about any previous marriages: Information about children: *Please place a “PM” beside any children from a previous marriage*. *Please place an “NL” beside any children not living*. *Please place an “A” beside any adopted children*. Name Birthdate Sex Education Marital Status Name Birthdate Sex Education Marital Status Name Birthdate Sex Education Marital Status Name Birthdate Sex Education Marital Status Name Birthdate Sex Education Marital Status Does your family regularly read the Bible and pray together? Yes No If you are human, leave this field blank. Next Page
