Profile Form and Questionnaire

Name

Address

City

State

Zip

Telephone

Email address

Age

Astrological sign (if known)

Height

Weight

Eye color

Hair Color

Occupation

Education

Religion

Relationship Status

Do you have children? If so, please tell us about him/her

Do you Smoke? Yes No If so, how often?

Do you drink alcoholic beverages? Yes No If so, how often?

Do you exercise?

Do you go for regular medical check-ups?

Are you sexually active?

Is sex an important part of your relationship?

Are you financially secure?

Please list some of your hobbies

How would you describe your sense of humor?

Which is your favorite season (spring, summer, fall, winter), and why?

Do you like to dance? If yes, what type of dance do you enjoy?

What type(s) of music do you enjoy?

What do you like to do for fun?

What is the last book you read?

What kinds of sports and exercises do you enjoy? (please circle all that apply)

Aerobics Basketball Cycling Golf Martial Arts Soccer Volleyball Yoga Auto Racing Billiards/Pool Dancing Hockey Running Swimming Walking/Hiking Weightlifting Baseball Bowling Football Inline Skating Skiing Tennis/Racquet Sports

Other-Please list:

Which of the following describes your daily diet? (please circle)

Meat & Potatoes Vegetarian/Vegan Health Nut Junk-food Junkie All chocolate, all the time Other

None of the above:

Do you have any pets? If so, please list

How would you describe an ideal date?

Which would you prefer to do on a date? (Please choose one)

Dancing in a nightclub Picnic in the park Amusement Park Dinner and a movie Evening stroll on the beach

None of the above:

Who has been your most influential person in your life, other than your parents and why?

What are 3 things you are most thankful for?

Please choose from the list below all that best describe you:

Warm Agreeable Aloof Impulsive Frugal Intelligent Neat Perfectionist Uncomplicated Communicative Patient Passionate Over-Achiever Show-off Aggressive Restless Clever Modest Quarrelsome Stable Predictable Compassionate Content Creative Generous Honest Reliable Caring Vivacious Independent Persistent Romantic Dominant Submissive Cold Energetic Affectionate Attractive Humorous Spontaneous Intellectual Sensual Resilient Genuine Wise Kind Outspoken Selfish Ambitious Lazy Gregarious Spiritual Jealous Loyal Efficient Sensitive Disciplined Liberal Optimistic Open Bossy Calm Rational Shy Outgoing Introverted Arrogant Adventurous Organized Witty Artistic Under-Achiever Adaptable Charming Conservative Competitive Leader Courageous Opinionated Stubborn Trusting

Choose 4 descriptions below that your friends would say describe you.

Good Spontaneous Dependable Ambitious Quiet Passionate Listener Fit Romantic Articulate Genuine Energetic Modest Warm Creative Rational Intelligent Funny Respectful Outgoing Loyal Easy-going Hardworking Perceptive Affectionate Optimistic Spiritual Generous Thoughtful Caring Kind Happy Sweet

Profile Form and Questionnaire

About you: