* 1. What is your contact information? First and Last Name, Email address, and Phone number

* 2. What is your age?

* 3. Are you male or female?

* 4. What city and state do you live in?

* 5. What is your profession? If retired, what was your profession?

* 6. What is your approximate average household income?

* 7. How many children/grandchildren do you have?

* 8. Are you now married, widowed, divorced, separated, or never married?

* 9. What are your hobbies and interests?

* 10. Are you seeking marriage or a committed long-term relationship?

What’s important to you in a committed relationship?

What physical traits are attractive to you in a partner?

What personality traits are attractive to you in a partner?

What physical traits are unattractive to you in a partner?

What personality traits are unattractive to you in a partner?

How would your best friends describe you – positive and not so positive traits?

How many long term relationships have you had? Explain

Are you willing to heal and clear any old hurts, beliefs and patterns that are holding you back from love? Explain

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