Dating Form
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Are you currently working or in school?
School
Working
Both
None
N/A
Other
Are you willing to go on blind dates?
Yes
No
Do you drink or smoke please be honest?
Both
Just Smoke
Just Drink
Other
Do you believe in going 50/50?
Yes
No
Fellas, are you looking for a submissive women?
Yes
No
Equally submissive
n/a
Ladies do you see yourself as a submissive women ?
Yes
No
For the right man
n/a
Which best fits your personality?
Funny, life of the party
Serious, like deep intellectual conversations
Shy, don’t really talk much, need to warm ip to people
Love people, can connect and get along with mostly anybody
How financially stable are you?
I’m making ends meet
I’m focused on goals to increase my finances
I make good money and I’m a position to invest
I make decent money and don’t want for anything
Out of the following which is most important.
Cooks and cleans
Makes good money
Affectionate, showers you with love
Does your partner need to make a certain amount or money
No
Yes, more then 100K
yes, more than 50,000
yes more than 75K
Where do you feel your communication level is?
Needs work
Excellent communicator
I shut down a lot
How patient do you feel you are?
My patience is thin
More patient then I should be
Patient but not letting anybody run over me
Your out and see your girlfriend/ boyfriend out on a date. Which of the following are you most likely to do?
Ignore talk about it later
Confront make a scene
Go home destroy their things put them out
Approach, say hi and walk off
How often do you go out?
1 or 2 times a week
3 or more times a week
1 or 2 times a month
Homebody
How often do you clean?
1 or 2 times a week stays clean
Everyday house spotless
Here and there I’m busy but the house ain’t nasty
Dirty house don’t bother me
Do you see yourself married one day?
Yes
No
Maybe
Do you have issues detaching from people?
Yes I have a hard time letting go
No I can cut anybody off
Sometimes, but once I’m done, I’m done
Do you want kids or more kids?
Yes
No
I’ll have them with the right person
If your partner wanted a threesome are you down?
Yes
No
Maybe
What sounds better after a long week?
Staying in resting, watching movies, ordering in
Going out with friends, maybe a bar or lounge
How often do you think a couple should have sex?
7+ times a week
3 or more times a week
1 or 2 times a week
Celibate
less then 3 times a month
Are you shy?
Yes
No
Do you have kids?
Yes
No
If you have kids how many?
1
2
3
More then 3
N/a
If you have kids how often do you see them?
Everyday
2-3 times a week
Holidays, spring break, summer
Not as often as I want
N/a
Would you date a person with kids?
Yes
No
No more then 3
What love language are you looking to receive the most?
Words of affirmation
Acts of service
receiving gifts
Quality time
physical touch
Marital status
Single
Divorced
Widowed
Other
What love language do you naturally give?
Words of affirmation
Acts of service
receiving gifts
Quality time
physical touch
Have you cheated before?
Yes
No
Raised in a 2 parent household?
Yes
No
How often do you see or speak to family?
Everyday
2 or 3 times a week
Once a week
Not often
Do you have or could you date somebody with a criminal background?
Yes
No
Maybe
What body type are you looking for?
Skinny
Athletic
Thick
Flyffy
Big dude
No preference
What body type do you have?
Skinny
Athletic
Thick
Flyffy
Big dude
Prefer not to say
Do you believe in GOD?
Yes
No
More spiritual
Believe in a higher being
What’s your ideal date?
Fancy dinner, dancing
Something active outdoors
Comedy show, sporting event
Some place romantic and quiet to talk
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Height
Give a brief description of yourself
What do you feel you have to offer your future partner?
What do you value most in a partner?
What are your deal breakers?
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