MARRIAGE COUNSELING GAP ANALYSIS FORM - TKP People Management Web Application

HOME
ABOUT US
COUNSELING SERVICES
BOOK APPOINTMENT
UPCOMING EVENTS
RESOURCES
FORMS
JOIN MARRIAGE CLASS
CONTACT US
REGISTER/LOGIN
Account

MARRIAGE COUNSELING
GAP ANALYSIS

Leave this field blank

POINT A – BACKGROUND

Full Name:

Length of Marriage:

How many children have you together?

Are You Born Again?

YES

Year of Salvation:

Year of Baptism:

Name of Church:

Name of Pastor:

Salvation Experience if applicable: (Few Words)

Are you Married before this Marriage?

YES

Is EX Living?

YES

N/A

Where is EX Living (If Applicable)

When did you divorce EX (If Applicable?)

Number of Children outside of the marriage

POINT B: X-RAY

Any Affair unknow to your spouse

YES

Occupation:

Employer:

Which of the issues on the list below on a scale of 0 to 3 is prevalent in your marriage (0) is “Not at all” (1) is Mild, (2) is “very much so”): (3) is “Terrible”

Secrecy

Communication Gaps

Declining Sexual Intimacy

Infidelity

Fighting About Money

Declining Appreciation and Love

In-Laws interference

Lack of Quality Time

Abuse- Emotional or Physical

Lack of Respect

Conflicts from Parenting

Which of the following emotions on the list below on a scale of 0 to 3 is prevalent in your marriage (0) is “Not at all” (1) is Mild, (2) is “very much so”): (3) is “Terrible”

Anger

Malice

Depression

Stress

Fear

Anxiety

Hatred

Were you happy at any time in this marriage?

YES

If above is YES; Why and What changed (In Few Words)

Do you feel occasionally threatened or scared living with your spouse.

YES

Do you have daily devotion together?

Seldom

Often

Daily

Not At All

POINT C - DREAM

List your Top 3 Desires and Expectations from this counseling Sessions?

In Your evaluation, List the Top 5 Things Your Spouse Must begin to Do for a Turnaround in Your Marriage?

List the efforts you have taken to see improvements in your relationship with your Spouse

Is Divorce an option for you?

YES

Please Explain your response to the above question if you can