Rekindled Onboarding Form

Form to be be completed by spouse one.

A healthy marriage takes work and intentionality. Thank you for having the courage to get help to rekindle your marriage. Pure Life Alliance understands the value of a united front when it comes to fighting for marriage as God designed it. This is why we partnered with Genesis Mediation to formulate the Rekindled program, to help build that united front.


We need to know a little more about each of you and your marriage in order to craft a personalized road map. Here are the next steps in the process. 

  1. You and your spouse each fill out this form separately. 

  2. Once the forms are received, you will each receive a short onboarding call. 

  3. Once we have spoken to both of you, we will schedule our planning session.

*If you are a member of the Pure Life Alliance group you can recieve the members discount

Family and Marriage Information

Therapy History

$499

1500 NW 167th Place

Beaverton, OR 97006

503.481.0729

[email protected]