ALCOHOL OR DRUG ABUSE COUNSELING
________________________________ (Name of the Husband or Wife), the ________ (Husband or Wife) agrees to attend counseling with ____________________________ (Name of Counselor) beginning no later than _______________ (Date) and extending for at least ________ (Number) months. This counseling is for the treatment of his/her alcohol/drug dependence. This counseling will be a further attempt to strengthen the marriage and manage resources effectively.
________________________________ Signature of Wife
_____________________ Date
________________________________ Signature of Husband
_____________________ Date
_______________________________ Signature of Witness
_____________________ Date