ZENOBIA'S PATH TO LOVE
Dating Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Please select the category that includes your age
18-24
25-34
35-44
45-54
55-older
What is your sexual orientation?
Straight
Homosexual
Other
Please indicate your gender
Female
Male
Other
Do you smoke?
Yes
No
Do you Drink?
Yes
No
Sober
Do you use drugs?
Yes
No
Sober
How would you describe your personality?
Shy and outgoing
Brave and talkative
Easy-going and cheerful
Honest and reliable
Sympathetic and tolerant
Energetic and open minded
Other
What traits do you look for in a partner?
Kind
Energetic
Honest
Naive
Talkative
Moody
Open minded
Respectful
Passionate
Good looks
What kind of music do you enjoy?
R&B
Rap/Hip Hop
Jazz
Classical music
Rock
Country
Metal
What's your favorite food?
Mexican
Sushi
Vegan
Vegetarian
Italian
Other
How do you feel about pets and animals?
not very much
1
2
3
4
very like
5
1 is not very much, 5 is very like
How would you describe your soulmate?
What are some of your hobbies or pass times?
What's the number one thing that you think makes a relationship last?
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How serious are you about marriage?
I was born ready!
I think I'm ready.
My friends / family are pressuring me!
I guess It's time.
Do you want kids?
I think I'm ready.
Hell yes!
It's up for debate.
Do you have kids?
Yes
No
All over 18
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Are there zodiacs you avoid dating?
Yes
No
Which do you avoid?
Aquarius
Pisces
Aries
Taurus
Gemini
Cancer
Leo
Virgo
Libra
Scorpio
Sagittarius
Capricorn
Which do you Fall for or like the best?
Aquarius
Pisces
Aries
Taurus
Gemini
Cancer
Leo
Virgo
Libra
Scorpio
Sagittarius
Capricorn
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Where did you grow up?
How many siblings do you have? Whats the relationship with them like?
What type of household /family setting did you have?
What's your relationship with your parents like?
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What type of family/ home life do you desire?
Do you have a plan for handing conflict with your mate?
Will you sit down and discuss plans for finances, parenting, vacationing and other important things before too much time goes by?
How will you handle things if your family or friends don't like your partner (your kids especially) or vise versa? Is this a deal breaker situation?
What are your deal breakers?
Are you open to dating someone who has NOT had a one on one coaching session with us?
Is there anything you'd like to add to best help your matchmaker make the best selection for you?
Should be Empty: