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LIFELINE CHURCH COUPLES ASSESSMENT
GENERAL INSTRUCTIONS

1. Please complete the couples assessment below in its entirety.

2. As a Partner of Lifeline Church, please be advised that all marital counseling will be assigned to our Lifeline Counseling Team (NOT Reggie & London) based on need and availability. Marital counseling by Reggie & London can be requested via www.marriedlifechicago.com.

3. If you should have any questions regarding the couples assessment, please call the LC Partner Care at 708 477-6686.

4. All information will be kept confidential.
Email *
COUPLES ASSESSMENT
GENERAL INFORMATION
Today's Date *
MM
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DD
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Your Name *
Address *
Home Telephone *
Work Telephone *
Your Age *
Spouse's Name *
Are you currently living together? *
Length of Association: *
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