Client Questionnaire

Dating Questionnaire

To be completed at the time of the client interview
Date

MonthDayYear
Matchmaker
Client Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Gender*

MaleFemale
Marital Status*

MarriedDivorcedSingleWidowed
I am seeking a*

MaleFemale
Between the Ages of:*
What are some important qualities you seek in a mate?
Include age, personality traits, children, religion, income, and hobbies
Tell us something about you?
Personality traits, children, religion, income, and hobbies
Tell us about your last marriage/ relationship?
# of times married, length of last relationship, why did it end, still communicating
What are some of your challenging personality traits?
Traits your mate may think is difficult to handle
What are some things you would alter regarding your current situation?
Including children, job, education, car, family, residence, relationships
What are some things you are willing to compromise for the right person?
Height, education, appearance, income, children, religion
What are some of your hard stops?
Things you will not tolerate
Current photo
How did you hear about us?*
Google, Bing, Website, Service
By Signing, you agree that you are over 21 years old and accept to receive email and/or phone messages from Lifetime Soulmate:*

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Dating Questionnaire