Profile Form and Questionnaire

About you:

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 and potatoes
Keep it healthy
Vegetarian
Junk food junkie
 All chocolate, all the time
Vegan
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
How would each of the following describe you:
 Not at AllSomewhatVery Much
Like to Joke
Enjoy work
Like Socializing with People
Like Reading
Satisfied with Your Level of Emotional Development
Physically Active
Able to Express Yourself
Religious Beliefs Important
Strive for Career Advancement
Can Converse With People I've Just Met.
You Think Outside the Box
You Are Well-Adjusted
You Take Time to "Veg Out"
You are Artistic
You See Humor in Everyday Life
You Care About Your Appearance
You Analyze Life
Like to Work Out
Can Make Others Laugh
You are Emotionally Stable
Easily irritated
Like to Be Pampered
Please select whether the statements pertains to you (True) or not (False)
True
False		Like many different types of recreational activities
True
False		Always read warning labels before taking medications
True
False		Drive faster than the posted speed-limit
True
False		Store clerk gave too much change, do you keep it without saying anything
True
False		Like to come out ahead
True
False		Dislike some people
True
False		Worry about work-related issues
True
False		Waste time when I should be working
True
False		You would lie, even if it doesn't hurt anyone
True
False		Have raised your voice in anger
True
False		You care what people think of you
True
False		You make fun of people behind their backs
True
False		You are envious of other people's possessions
True
False		Your house is cleaner when I have company coming over
True
False		You're always even-tempered

Relationship History

Please list the ways in which you have met women to date, i.e. in a bar, grocery store, etc.
Please give us a brief history of past relationships and some of the reasons on why they didn't work out.
How many times have you been on a date in the past two years?
How many times have you been married?

Personality Test

In this section, please select if you agree/disagree with the statements.

1. I'm a romantic.
Strongly agree
Agree
Disagree
Strongly disagree
2. I set ambitious goals for myself, and I work hard to achieve them.
Strongly agree
Agree
Disagree
Strongly disagree
3. I have lots of energy.
Strongly agree
Agree
Disagree
Strongly disagree
4. I enjoy spending time with friends.
Strongly agree
Agree
Disagree
Strongly disagree
5. I keep in close touch with my friends and family.
Strongly agree
Agree
Disagree
Strongly disagree
6. I have a positive outlook on life.
Strongly agree
Agree
Disagree
Strongly disagree
7. I am trustworthy.
Strongly agree
Agree
Disagree
Strongly disagree
8. I am spontaneous.
Strongly agree
Agree
Disagree
Strongly disagree
9. I'm a workaholic.
Strongly agree
Agree
Disagree
Strongly disagree
10. I prefer consistency in my life.
Strongly agree
Agree
Disagree
Strongly disagree
11. I'm a kind person.
Strongly agree
Agree
Disagree
Strongly disagree
12. I like most of the people I meet.
Strongly agree
Agree
Disagree
Strongly disagree
13. My appearance is important to me.
Strongly agree
Agree
Disagree
Strongly disagree
14. I can be a jealous person.
Strongly agree
Agree
Disagree
Strongly disagree
15. I am opinionated.
Strongly agree
Agree
Disagree
Strongly disagree
16. I value my possessions, as they are a sign of my success.
Strongly agree
Agree
Disagree
Strongly disagree
17. I like intellectual conversations.
Strongly agree
Agree
Disagree
Strongly disagree
18. I'm a tense person.
Strongly agree
Agree
Disagree
Strongly disagree
19. I like who I am.
Strongly agree
Agree
Disagree
Strongly disagree
20. I like things to be unpredictable.
Strongly agree
Agree
Disagree
Strongly disagree
21. I'm a soft-hearted person.
Strongly agree
Agree
Disagree
Strongly disagree
22. I thrive on competition.
Strongly agree
Agree
Disagree
Strongly disagree
23. I communicate well.
Strongly agree
Agree
Disagree
Strongly disagree
24. I'm a worrier.
Strongly agree
Agree
Disagree
Strongly disagree
25. I always need to be doing something.
Strongly agree
Agree
Disagree
Strongly disagree
26. I am open-minded and able to think outside the lines.
Strongly agree
Agree
Disagree
Strongly disagree
27. Overall, I'm satisfied with myself.
Strongly agree
Agree
Disagree
Strongly disagree

Life Skills

Please select how skilled you are in the following situations in regards to your personal life.

 Not SkilledModerately SkilledHighly Skilled
Achieving goals you set for yourself
Home improvement/repairs
Organization
Managing finances
Raising children
Socializing
Communicating my thoughts/feelings
Helping those in need
Understanding world events/politics
Making new friends
Cooking for family and friends
Car maintenance/repair
Maintaining household
Being a good companion

Your Relationship Style

How important are the following to your relationship?

 Not ImportantSomewhatVery Important
Having similar interests
Revealing past relationships/history
Being able to count on her for support
Having similar ideas about parenting/children
Being able to spend time with her
Doing special things for her
Compromise
Good communication
Being kind to each other
Being able to be angry at times
Having space to myself
Being open about yourself
Having her be open to you
Having similar beliefs about religion

Your Self-Description

Please write a paragraph describing what life with you would be like.
Please write a paragraph describing your home:
Please write a paragraph describing your city:
Please write a paragraph about your work/career and what interests you about? What drew you to it?
What are you passionate about?
Please tell us how you view a woman's role in your family:
What quality(ies) do you admire the most in a person?
What quality(ies) do you least admire?

About Your Lady

What is the minimum age of the lady?
What is the maximum age of the lady?
How important is the age of the lady to you?
Not at all
Somewhat
Very Important
What color are her eyes?
What color is her hair?
What is her weight?
What is her height?
What is her dress size?
What does she like to wear on a casual basis, semi-casual or dressing to go out with friends for dinner?
How important is physical attraction?
Not at all
Somewhat
Very Important
How important is physical attraction?
Christian   Jewish   Muslim   Buddhist   Protestant   Spiritual   Other
Do you prefer your lady to be a smoker or non-smoker?
Do you prefer your lady to be a drinker or non-drinker?
Would you accept that your lady has children 18 years old or younger living at home?
What type of education should she have?
What is her marital status?
Where does she live, i.e. a big city, on a farm, etc?
What is her English level (ability to speak English)? What other languages does she speak?
Is she career-oriented? If so, do you want her to continue her career, or be a homemaker?
Please choose from the list below all that describe your lady:
Warm
Agreeable
Aloof
Impulsive
Frugal
Intelligent
Neat
Perfectionist
Uncomplicated
Communicative
Patient
Passionate
Over-Achiever
Show-off
Aggressive
Restless
Trusting
 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
Which common interests would you like to share with your lady? (Please check as many as apply)
Book Clubs
Fishing/Hunting
Movies
Theatre
Shopping
 Camping
Museums
Playing Cards
Travel
 Cooking
Gardening/Landscaping
Art
Sports
Video Games
 Dancing
Music/Concerts
Politics
Volunteering
 Dining Out
Hobbies and Crafts
Nightclubs
Religion
Wine Tasting

Other - Please list:
How important are the following characteristics in finding your partner:
 Not at AllSomewhatVery Important
Her personal values
Her energy level
Her family background
Her honesty
Her dependability
Her intelligence
Her sex appeal
Her love of children
Her beliefs
Her fun-loving nature
Her physical appearance
Chemistry between her and I
Similarities between her and I
Romantic attraction I feel for her
Her personality
Her kindness
Sexually compatible
Her ability to communicate
Her ability to resolve conflicts
Her friendliness
Friendship between her and I
Her capacity for emotional intimacy
Please describe your ideal woman: