PAIN 2 LOVE
Client interview
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Orientation:
Client Name
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First Name
Last Name
Referred by
First Name
Last Name
Age
*
Gender
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Male
Female
Marital Status
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Married
Divorced
Single
Widowed
Is seeking
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Male
Female
Is seeking age range of
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What are some important qualities you seek in a mate?
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Include age, personality traits, children, religion, income, and hobbies
Tell us something about you?
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Personality traits, children, religion, income, and hobbies
Tell us about your last marriage/ relationship?
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# of times married, length of last relationship, why did it end, still communicating
What are some of your challenging personality traits?
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Traits your mate may think is difficult to handle
What are some things you would alter regarding your current situation?
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Including children, job, education, car, family, residence, relationships
What are some things you are willing to compromise for the right person?
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Height, education, appearance, income, children, religion
What are some of your hard stops?
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Things you will not tolerate
Current photo
*
1-2 MIN VIDEO (Explain what makes you hard to love?)
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