Clients must electronically SUBMIT this questionnaire at least 48 hours before the first scheduled session. Everything stated in the questionnaire is confidential. Please fill out the form below by typing your answers and pressing the submit button at the end. Please check your spam folder first if you have not heard from us within 3 to 5 business days. By clicking the submit button, you agree to our Terms & Conditions. Jazak Allah khayran. Please enable JavaScript in your browser to complete this form.Full Name *Email *Phone Number *Current Location *Name of Potential Spouse *Your Ethnic Background *Where did you live from the ages of 10 to 25? *Your Age *Are you a student? How many hours per week? *Are you working? What is your occupation? How many hours per week? *How did you meet each other? How long have you been talking? * impact family family If you were to marry, when would the potential contract (nikah) be and when would you start living together? *Are your families involved? Do they approve of your potential marriage? Please state any relevant concerns. *Have you previously studied the rulings related to marriage and divorce? Have you taken any other marriage courses? Please provide details. *Have you spoken about spousal roles? For example, who will work, cook, raise kids, etc. Please state any relevant concerns. *Have you spoken about how to manage the finances and budget money? Will you do 50/50 or each person's money is their own? Please state any relevant concerns. *Have you spoken about life goals, career goals, and family planning goals (like when to have children)? Please state any relevant concerns. *Have you spoken about your family's expectations and cultural differences of how to interact with parents and other family members? Please state any relevant concerns. *Have you spoken about your childhood and religious upbringing? Please state any relevant concerns. *How long have you been practicing Islam? How do you believe Islam should be practiced on a daily basis? For example, discuss your views about praying five times a day, fasting Ramadan, giving zakat, and following a madhhab. *What are your views about interacting with the opposite gender? What if they are extended family members like cousins? *Have you ever been previously married? How many times? Do you have kids from your previous marriages? How recent was your last divorce? *Do you have a history of drug use, depression, anxiety, suicidal thoughts, or anger problems? Have you sought professional therapy for this issue? Please state any relevant concerns. *Do you currently take medication for depression, trauma, or any psychological disorder? Have you done so in the past? *What was your parents' marriage and your childhood with them like? Was it happy? How did that impact you? *Which option do you prefer? Please note that if you are currently experiencing issues with your potential spouse, it is better to sign up for couples counseling instead of the premarital program. *Premarital Program (4 x 60 minute structured sessions with set content for $250 USD/£199 GBP)Couples Counseling (1 x 90-minute session with client-led content for $120 USD/£85 GBP for 90 minutes)Let counselor suggest what’s bestWhich days/times are suitable to meet? Choose as many as applies. *1 pm to 5 pm UK / 8 am to 12 pm NY6 pm to 9 pm UK / 1 pm to 4 pm NYMondayTuesdayWednesdayThursdayFridaySundayHow did you hear about us? Choose as many as applies. *Google searchWhatsApp groupTelegramInstagramFacebookLinkedinPsychology TodayFamily / FriendOtherSubmit
