Pre-Marital Mentoring Confidential Intake Form
Thank you for taking the time to fill out this confidential questionnaire. We understand some of the following questions are very personal, so we want you to know we take your confidentiality very seriously. This information will be shared only with the mentoring couple you will be assigned and the Wholeness Director, Carolyn Lu, who will review it in order to find the best mentor couple match for you. Please do your best to answer every question thoroughly and honestly. However, if you feel you can’t answer a certain question, just fill out those you are able.
Name of Bride
Your answer
Name of Groom
Your answer
Wedding Location
Your answer
Name of Officiating Pastor (person performing the wedding)
Your answer
Phone
Your answer
Wedding Date
MM
/
DD
/
YYYY
Sponsoring Pastor (if not the same as above - RHCC pastor if wedding is performed by an outside pastor)
Your answer
Are you Engaged?
If yes, for how long?
Your answer
How long did you date before you got engaged?
Your answer
We are presently living together.
In the past, we have been involved together in a sexual relationship.
We are currently sexually active together.
We are expecting a child and/or we have children together.
If yes, please give your due date or the names and ages of your children:
Your answer
What are the best days and time of the week for meeting with your mentors?
Your answer
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