Recommit, Restore, and Renew Marital Assessment

Greetings!

We are so excited about being with you at the Recommit, Restore, and Renew Marriage Enrichment Seminar. We want to make this experience as positive and personal as possible. One thing that is unique about our marital enrichment seminar is we use this assessment to ensure that we are prepared to address the issues that are most common for those who actually attend. We will prepare an individualized conversation guide for you and your spouse that will be utilized in the seminar. You and your spouse must each individually complete this short survey. The results will automatically be shared with us when you submit the survey. We will not share your information with anyone! If you would like to talk to us prior to the event, contact us at david@fruitfulvinefamilyministries.org.

If you are not comfortable submitting this information in an online format, call 252-514-1635. David or Cheryl will help you complete the assessment by phone.

David and Cheryl Morrow

Instructions: Complete the demographic and other information that is requested. Beginning with #10, read the statement and choose a number between 0 and 10 with 10 indicating that you totally agree with the statement, and 0 indicating that you totally disagree with the statement. For example, if you feel somewhat disrespected during arguments, you might rate statement 11 as a “5”. If one of the statements does not apply to you, such as the statement about drugs and alcohol, and you feel safe with that, then rate that one as a 10. If you do not have any children (biological, foster, adopted, or step) respond to the second statement for numbers 26, 27, and 28. The primary purpose of this questionnaire is to determine what issues may need to be discussed during the seminar. It should not be used for any other purpose.

Your First Name

Your Last Name

Your Email Address

Do you want to receive the FVFM Newsletter?

1.

Spouse's Name (First and Last)

2.

Spouse's Email (This ensures we connect the husband and wife correctly.)

3.

Why are you taking this assessment?

4.

Your Wedding Date

5.

How long did you date prior to marriage?

6.

Have you had previous marriages or partners with whom you shared a home? If yes, state how many previous relationships.

7.

Are you blending two families? (Do you or your spouse have children from previous relationships?)

8.

In the last six months, have you seriously thought about or discussed divorce or separation?

9.

Has there ever been any physical violence in your relationship?

10.

I feel 100% safe emotionally, physically, and sexually in my marital relationship.

0 1 2 3 4 5 6 7 8 9 10

11.

When my spouse and I argue, we remain respectful and loving toward one another during the argument.

0 1 2 3 4 5 6 7 8 9 10

12.

I am satisfied in the sexual aspect of our relationship.

0 1 2 3 4 5 6 7 8 9 10

13.

My need for romance is met.

0 1 2 3 4 5 6 7 8 9 10

14.

My spouse will listen to me about anything, and I know that I will not be ridiculed now or in the future.

0 1 2 3 4 5 6 7 8 9 10

15.

When my spouse and I are physically a part, I am comfortable with the way we both behave.

0 1 2 3 4 5 6 7 8 9 10

16.

I am comfortable with my friends, my spouse's friends, and our friends.

0 1 2 3 4 5 6 7 8 9 10

17.

Our relationships with extended family members always has a positive impact on us.

0 1 2 3 4 5 6 7 8 9 10

18.

I feel secure in the way my spouse and I manage our finances.

0 1 2 3 4 5 6 7 8 9 10

19.

I am comfortable with each of our employment situations.

0 1 2 3 4 5 6 7 8 9 10

20.

My spouse and I are growing spiritually as individuals and as a couple.

0 1 2 3 4 5 6 7 8 9 10

21.

I feel that my spouse and I manage our physical health well.

0 1 2 3 4 5 6 7 8 9 10

22.

Emotionally, my spouse and I are in a good place.

0 1 2 3 4 5 6 7 8 9 10

23.

My spouse and I take care of legal issues appropriately.

0 1 2 3 4 5 6 7 8 9 10

24.

I feel safe when I think about the way my spouse and I use alcohol and drugs.

0 1 2 3 4 5 6 7 8 9 10

25.

My spouse and I divide the household chores in a way I believe is fair.

0 1 2 3 4 5 6 7 8 9 10

26.

I am comfortable with the way my spouse and I share the responsibilities of raising our children, OR Presently, my spouse and I do not have any children, and I am completely comfortable with that.

0 1 2 3 4 5 6 7 8 9 10

27.

We are providing a positive environment, and modeling a positive marriage for our children, OR We provide a positive environment for each other, and model a positive marriage for our community.

0 1 2 3 4 5 6 7 8 9 10

28.

I am comfortable with the way my spouse and I discipline our children, OR My spouse and I have discussed the discipline of a child, and if we had a child, we agree on how to do this.

0 1 2 3 4 5 6 7 8 9 10

29.

I am excited about our future; we have mutual goals and dreams, and are making progress.

0 1 2 3 4 5 6 7 8 9 10

Are you a bot? If not, type what you see below.

Thank you so much for completing the assessment. It is our goal to maintain your confidentiality, to prepare a personalized conversation guide just for you and your spouse, and to create our seminar specifically with you and the other attendees in mind. You will receive your conversation guide and other materials at the beginning of the seminar. If you have any questions or concerns about the seminar, do not hesitate to contact David or Cheryl. You can utilize David's email (david@fruitfulvinefamilyministries.org), Cheryl's email (cheryl@fruitfulvinefamilyministries.org) or David's cell, which is 252-514-1635. Likewise, if we have any questions or concerns that should be addressed prior to the seminar, we will contact you as well. See you in Black Mountain!

Recommit, Restore, and Renew Marital Assessment

Greetings!

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