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Bride Profile Form

Bride Profile Form

If you have decided to take the next step in the process of pre-marital counseling with us, we would like to use this "Personal Profile" to learn a little more about you.

Please take your time filling this form out and please complete it as accurately as possible. Once you complete and submit this form it will be kept in the strictest confidence and reviewed only by Todd LaVine.

After it has been reviewed we will call to schedule a time for our interview process. Please remember that at this point there is still no cost or obligation.

This interview process will ensure that both parties feel that this relationship is a good fit. If you would like to proceed from there, we will set a day and time to begin your pre-marital counseling.

Name and Address
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Contact Information
Home Phone:
Cell Phone:
Email:
Other Information
Date of Birth: *
Occupation: *
Have you been married before?:
Do you have any children?:
Do you agree to abstain from sexual relations prior to marriage?
Do you agree not to live together prior to marriage?:
Are you a born again Christian?:
Year of conversion?: *
Testimony: *
Do you intend to be involved in a local church after married?:
Are you engaged?:
Has a wedding date been set?:
If so, when? *
Any additional questions?: