Scripture-Focused Couples Therapy Intake
Couple Information
Partner 1 Full Name
Partner 2 Full Name
Partner 1 Date of Birth
Partner 2 Date of Birth
Partner 1 Contact
Partner 2 Contact
Address
Marriage Details
Length of Relationship / Marriage
Children (names and ages)
Religious Affiliation / Church
Spiritual Background
Describe your faith journey as a couple
How do you integrate scripture in your daily life together?
Therapy Goals
What brings you to scripture-focused couples therapy?
What outcomes or changes do you hope to see?
Personal Challenges
Describe any current challenges or conflicts in the relationship
Have you sought previous counseling?
Yes
No
If yes, briefly describe your experience
Additional Notes
Anything else you'd like your therapist to know?