Counseling Process and Personal Information Form

Dear Brother or Sister

Assalaamu Alaykum

Jazak Allah Khairan for your email requesting Marriage or Pre-Marital Counseling. Please follow the simple process mentioned below:

1. For Premarital counseling please fill out the form below and email us at Please make sure to include the Skype name that you use along with the preferred days and times that you are available.

2. For marriage counseling email us at details of the issues that are plaguing their marriage. The more details the better. These emails should come separately from the husband and wife so that each will have the independence to say what is on his or her mind.

3. After we receive the emails, we will form a strategy on how best to proceed and to resolve the issues.

4. We do all of our counseling based on the Quran and Sunnah Alhamdullilah.

5. They also will need to email back the information form below.

6. We can set up a mutually convenient day and time to start counseling. We usually do counseling on weekday evenings or weekends.

7. Each session is 50 minutes in length so please block this amount of time without interruption (telephone, other commitments, etc).

8. All counseling is done using Skype or Google hangouts. Each participant must have their camera on for us so that we can observe the facial expression and body language that is just as critical as the verbal.

9. Our charges are $50 per session however anyone not able to pay this amount can just send us a quick email at as to how much they can afford for each session.

10. We are a 501C3 non Profit organization. Donations are welcome to support our work. All donations are tax deductible. Your donations will be used to develop program for the families in need and will be Sadaqa-jariah (continuous charity) for the donors. This donation can be made through the website by pressing the donation button.

11. Please contact us at if you have any further questions.

Please fill out the following information for counseling

My spouse and I (Fiancé) need Pre-marital counseling ______ or Marriage counseling ______

Your Name First: ____________________________ Middle _______________ Last __________________

Address: _____________________________________________________________________________

City _____________________________________ State: ________ Zip Code: ______________________

Email ______________________________________ Phone: ( ) _________ ______________________

Profession: _____________________________ Skype Name: __________________________________

Your Spouse (Fiancé’s) Name First: ____________________ Middle _________ Last ________________

Address: (If different than yours) ___________________________________________________________

City _____________________________________ State: ________ Zip Code: ______________________

Email ______________________________________ Phone: ( ) _________ ______________________

Profession: ___________________________ Skype Name: ____________________________________

No of children ______ Their gender and ages: _____________________________________________________

Select preferred day and times from the following: (Please give two or three options). All times are based on the
Eastern Time US

Weekday evening ____ Mon ___ Tues ___ Wed ____ Thurs ____ Fri

_____ 6 pm to 8 pm _______8 pm to 10 pm

Weekend ____ Mornings between 10 am to 12 noon ____ Afternoon 1 pm to 4 pm

Please send a separate email at
with information about the two of you and detailing the reason for your request for counseling and the issues you wish to discuss.

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