Couples Questionnaire

I am willing to (check all that apply): *

Forgive my spouse/partner for past hurts Take responsibility for my part Practice new communication habits Ask for what I need in the relationship Work toward win/win solutions Be mindful of how I speak Not verbally attack my spouse/partner Walk in obedience to the Lord with regards to my God-given role as a husband/wife Complete any homework assignment provided by my counselor

Confidentiality and Indemnification Clause: The counseling provided through this ministry is offered by a certified holistic health counselor and not a state licensed counselor. Any advice, suggestion, or recommendation provided through this ministry is based upon biblical principles and should not be considered professional legal, financial, medical, psychiatric, or technical advice. Therefore, if you have a significant legal, financial, medical, psychiatric, or technical need, please seek assistance from an independent licensed professional, accordingly. Confidentiality is an important aspect of the counseling process, and the information you entrust to this ministry will be carefully guarded and not shared outside of this ministry. I acknowledge that any advice, suggestion, or recommendation made through this ministry will be acted upon by my own volition and free will. I take responsibility for all decisions and choices I make based on the counsel I receive through this ministry. I further promise and agree to indemnify and release Holistic Christian Therapies, and Stephanie Stanton, of any and all liability arising from any known, unknown, or any unanticipated damages to myself, others, or property caused by the decisions and choices I make as a result of the counsel I receive through this ministry. I am fully aware of, understand, and agree to all the terms and conditions of this release and indemnification provision, and that it is binding and enforceable by law.

Couples Counseling

Questionnaire