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LIFELINE CHURCH MARRIAGE SURVEY
GENERAL INSTRUCTIONS

1.Please be advised that all marital counseling will be assigned to a Lifeline Church Clergy member based on need and availability. All non LC Partners requesting counseling will be assessed a fee of $75.00 per hour.

2. The LTI Married Life Class is a prerequisite for marital counseling.

4.If you should have any questions regarding the survey, please call the LC Member Care Office at 708 477-6686.

5. All information will be kept confidential.

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MARITAL SPIRITUAL GUIDANCE SURVEY
GENERAL INFORMATION
Today's Date
MM
/
DD
/
YYYY
Your Name
Your answer
Address
Your answer
Home Telephone
Your answer
Work Telephone
Your answer
Your Age
Your answer
Spouse's Name
Your answer
Are you currently living together?
Length of Association:
Your answer
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This form was created inside of Lifeline Church. Report Abuse - Terms of Service - Additional Terms