Upper Echelon Matchmaking Intake Form
Welcome, and congratulations on taking this step! This intake form helps me understand who you are, what you're looking for, and how to best match you. Please answer as honestly and openly as possible. The more I know, the better I can serve you. This form takes approximately 15-20 minutes to complete.
Section 1: Let's Start With the Basics
Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Primary Residence: City, State
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Phone call
Text
Email
Section 2: Who You Are
Gender identity / pronouns
*
Male
Female
Non-binary
Prefer to self-describe
Ethnicity / cultural background
Religious or spiritual beliefs and how important alignment is in a match
Political leaning and how important alignment is in a match
Do you have children? If so, share ages and custody arrangements
Do you want children or more children?
*
Yes
No
Open to discussing it
Not sure
Section 3: Your Relationship History
Current relationship status
*
Single
Divorced
Separated
Widowed
It's complicated
How long have you been single?
What was your longest relationship and why did it end?
Have you noticed any patterns in your past relationships?
Section 4: What You're Looking For
Age range(s) you're open to
*
26-30
31-35
36-40
41-45
46-50
51-55
Other
What are your non-negotiables in a partner?
*
What are your dealbreakers?
Preferred physical type — judgment-free zone
Where do you see yourself in 3-5 years relationally?
*
Section 5: Your Lifestyle
Occupation and industry
Income range, annual
Under $100K
$101K-$150K
$151K-$200K
$201K-$300K
$301K+
Highest education level completed
High School
Some College
Bachelor's Degree
Master's Degree
Doctorate Degree
Trade Degree
Certifications
Other
Do you own or rent? Are you open to relocating?
How do you spend your free time?
Describe your social life and whether you are an extrovert, introvert, or ambivert with elaboration
Fitness and health habits or aspirations
Drinking, smoking, or other lifestyle habits
Section 6: Deeper Personal Questions
Have you done personal development work such as therapy or life coaching?
*
Yes
No
Prefer not to say
What are you actively working on in yourself right now?
How do you typically handle conflict?
Are you open to feedback during the matchmaking process?
*
Yes, absolutely
Yes, with some boundaries
I'm working on it
No, I prefer to handle that on my own
Section 7: Practical Details
How far are you willing to travel for a date?
*
My city only
Within 1 hour
Within 2-3 hours
Open to flying domestic
Open to flying international
Ideal timeline for finding a match
*
I'd love something to happen soon (3-6 months max)
Up to 1 year
No rush at all
Are there specific communities or identities you want in a match? Faith, cultural background, lifestyle, etc.
Is there anything important about your life that hasn't been covered?
Section 8: Photo Shoot
Do you have recent professional photos you want to use, or will you need a photo shoot scheduled?
*
I have recent professional photos I want to use
I'll need the photo shoot
Do you have any scheduling constraints for coordinating a photo shoot?
Do you have wardrobe preferences, or would you like guidance?
*
I've got it handled
I'd love some guidance
Not sure yet
Upload 2 recent photos
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload 2 professional photos, if available
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload a full-body photo
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Consent
*
I understand these photos are for matchmaking and profile review purposes only and will not be shared publicly without my permission.
Submit
Should be Empty: