Boomers Survey
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1
. Your Gender?
Your Gender?
Male
Female
2
. Age
Age
47-50
51-55
56-60
61-65
66-70
71+
3
. Have you ever been married?
Have you ever been married?
Yes
No
How long were you married?
4
. How long have you been single?
How long have you been single?
Less Than 5 years
6-10 years
11-15 years
16-20 years
20+ years
5
. How frequently do you date?
How frequently do you date?
Never
Once A Year
Once Every 6 Months
Once Every 3 Months
Once A Month
Once A Week
6
. When was the last time you dated on a regular basis?
When was the last time you dated on a regular basis?
Less Than 5 Years Ago
5+ Years Ago
10+ Years Ago
15+ Years Ago
20+ Years Ago
7
. Would you like to marry or find a long-term companion?
Would you like to marry or find a long-term companion?
Yes
No
Not Sure
8
. How do you feel about marrying or finding a long-term companion?
1 100% Pessimistic
2
3
4
5 Equally Pessimistic and Optimistic
6
7
8
9
10 100% Optimistic
1
*
How do you feel about marrying or finding a long-term companion? 1 1 100% Pessimistic
1 2
1 3
1 4
1 5 Equally Pessimistic and Optimistic
1 6
1 7
1 8
1 9
1 10 100% Optimistic
9
. Are you currently sexually active?
Are you currently sexually active?
Yes
No
10
. If you are not currently dating, what are the primary reasons for not doing so (please list all that apply)
If you are not currently dating, what are the primary reasons for not doing so (please list all that apply)
Not interested
Difficulty meeting people
Fear - apprehension because I haven’t done it for so long
Money
No access to age appropriate environments
Other - Fill in the blank.
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