* How did you hear about us? Select one Grace Website Promo/Announcements Friend Facebook Grace Staff Member Google Search for Marriage Help Other
* The church I usually attend is: Select one Grace Other None
* Describe your belief system about God: Select one I don't beieve in God I am not sure what I believe I have put my faith in Jesus, the Son of God I am of the Muslim faith Other
* What best describes your marital status? Select one Newlywed (less than 2 years) Married Blended Family Separated Divorced
* Please rate your marriage on a scale of 1 to 10 with 10 being perfect Select one 1 2 3 4 5 6 7 8 9 10
* Have you been married before? Select one Yes No
* Have you struggled with any of the following throughout your marriage? Sexual Addiction/Pornography Sexual Immorality/Adultery Addiction to Drugs/Alcohol Aggression/Rage Trauma Compulsive Lying/Hiding Things None of the Above