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* 1. Who is answering this questionnaire

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* 2. How long have you been married

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* 3. What is your marital status

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* 4. What are the biggest challenges in your marriage (top 3)

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* 5. What day of the week would be best for you to meet

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* 6. What time would work best

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* 7. On a scale of 1-10 (10 = Outstanding) I would rate my marriage a

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* 8. Do you have children at home in the following age groups?

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* 9. Any Questions or topics you would like to discuss at our sessions

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