The following 5 sections of this online assessment have been developed by Dr. Mark Britzman as part of his pre-marital workshop. All of your answers will be kept confidential and only shared with Dr. Britzman and your future spouse during your evaluation with Dr. Britzman. In order to get the maximum benefit of your assessment, you are encouraged to answer each question honestly and with no help from any outside sources.

Who is completing this assessment? Male     Female
Name (Female):
Phone:
Email:
Mailing Address:
Name (Male):
Phone:
Email:
Mailing Address:
Date & Location of Wedding: