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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.

Email address *
MARITAL SPIRITUAL GUIDANCE SURVEY
GENERAL INFORMATION
Today's Date *
MM
/
DD
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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