Marriage Works Registration
There is a one-time non-refundable registration fee of $100 for The Seven Principles for Making Marriage Work group which will be applied toward your group fee. If you are self-pay, the entire group fee must be paid prior to group start date. Your BCBS insurance may cover the workshop. Please contact billing with any questions before registering. One registration per couple.
Partner Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email (This is the email address to which your receipt will be sent)
*
example@example.com
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Partner Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Address (if different than previous)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
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Couple Information
I understand that this group is designed for heterosexual couples. The therapists at Family Strategies do not have specialty training to handle LBGTQIA+ issues that may arise. If I need a referral, I will call the office to inquire.
*
Yes, I understand this group is for heterosexual couples
Have you had previous experience with counseling or therapy?
*
Yes
No
If yes, what did you find helpful or unhelpful?
Please tell us about your relationship situation. If there is currently distress in your relationship, how serious is it?
*
Do you have any questions or concerns?
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Financial Information
How will you pay your group fees?
*
SELF-PAY - The entire fee for Marriage Works is due prior to the first night of group. You may pay the non-refundable registration fee at this time and contact the billing department to pay the balance due.
BCBS INSURANCE - Coverage will vary based on your deductible, co-pay, and co-insurance amounts. Please contact the billing department for more information on coverage.
Do you have BCBS Insurance?
*
Yes
No, I will be self-pay
Member ID
Group Number
Primary Subscriber's Full Name
First Name
Last Name
Primary Subscriber's Date of Birth
-
Month
-
Day
Year
Date
Subscriber's Relationship to the Participant
Please upload a copy of your BCBS Insuranace card
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Please send images of the FRONT and BACK of your most current card
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Payment Information
There is a non-refundable $100 deposit due at the time of registration that will be applied to the overall workshop fee. Some or all of your Marriage Works group fees may be covered by your BCBS insurance. If you have any questions about billing, please contact the Group Billing Specialist at (480) 668-8301 ext. 1030.
LIMITED TIME PRICING! ONLY $696.00 PER COUPLE!
USE COUPON CODE: FALL2025
Payment
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Making Marriage Work - Deposit only
$
100.00
This non-refundable registration fee will be applied to your overall group fees.
Making Marriage Work - Pay in Full
$
1,098.00
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Total
$
0.00
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