Start a Mindful MatchUp Account

Welcome to
Mindful MatchUp^™!

Completing this intake form is the first step to finding your forever partner! Let's get this party started!

Your privacy is extremely important to me. This form and the data it collects is encrypted and requires me to enter a password to access every time. I will never share your personal contact information with anybody.
1. First Name*
2. Last Name*
Gender*
Sexuality*
Birthday (accuracy is important!)*

MonthDayYear
Date
Region of Residence*
Profile Picture *

Cancelof
Phone Number*
RECOMMENDED: Create & share a non-personal phone number from Google Voice or Phoner.
Email*

Confirmation EmailRECOMMENDED: Create & share a generic email (without your full name in it) from Google.
Link to at least 1 social media profile (optional)

About You - Relationships
When are you typically available to date?*
What is your relationship status?*
TextingPhone CallsVideo CallsIn-Person
Please describe your communication expectations while dating. *
Have you had any relationships in the past?*
Do you have any kids?*
Please describe your past relationships. Include the duration of the relationship, general reasons why you were together, reasons you broke up, and lessons learned from each. *
Please share the ages of your children and any custody arrangements. *
Do you know your attachment style? *
Do you know your Love Language? *
Describe your strengths in a relationship. What makes you easy to be with?*
Describe your challenges in a relationship. What makes you difficult to be with?*

Thank you much for joining Mindful MatchUp! This information will help us personalize your experience so that you have as much authentic fun as possible while getting to know quality people in the meantime!
Yes: Opt-InNo: Opt-Out
Please verify that you are human*

My Products

Total

$0.00

Rows	Never	Sometimes	Often	Regularly
Drinking Alcohol
Smoke Cigarettes, E-Cigs, Vape, etc.
Smoke/Eat Marijuana
Other Drugs

Rows	Never	Sometimes	Often	Regularly
Meditate, Journal, Reflect, Tai Chi, Qui Gong
Yoga, Stretch, Walk, Barre
Run, Cardio, HIIT, Spin, Swim
Lift Weights, Machines
Compete (i.e. 5K, Marathons, Trails)
Activities (i.e. Play Sports, Martial Arts)

About You - Personality