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Are you interested in a consultation to become a client?

---- Yes, I'd like to learn more. No, I want to join your free database.

Birthdate

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

First Name

Last Name

Email

WhatsApp/Phone

Location

Instagram / @username

Basic Information

Gender

---- Female Male

Sexual Orientation

---- Straight Gay Lesbian Bisexual Other

Relationship Status

---- Never Married Divorced Separated Widowed

Ethnicity

---- Asian Black Caucasian East Indian Hispanic/Latino Indian American Middle Eastern Multiracial Pacific Islander Other

Faith/Religion

---- Buddhist Catholic Chinese Traditional Christian East Asian Eastern Orthodox Hindu Indigenous Jewish Muslim Non-religious Protestant Sikh Spiritual Other

Highest Education Level Completed

---- High School Graduate Some College Associates Degree Technical Degree Bachelors Degree Graduate Degree J.D./M.D./PhD

Occupation

Income

---- Less than $50k $50k - $100k $100k - $150k $150k - $250k $250k - $500k $500k - $1m $1m - $5m $5m + Would rather not share

Do you have children?

---- Yes, living separately Yes, living with me No

Do you want children/more children?

---- Yes No Undecided/Open

Height (ft & in)

---- 3' 0" 3' 1" 3' 2" 3' 3" 3' 4" 3' 5" 3' 6" 3' 7" 3' 8" 3' 9" 3' 10" 3' 11" 4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" 7' 1" 7' 2" 7' 3" 7' 4" 7' 5" 7' 6" 7' 7" 7' 8" 7' 9" 7' 10" 7' 11"

What is your weight (in lbs)?

Body Type

Athletic Average Curvy Fit Slender A few extra pounds

Hair Color

---- Bald Black Blonde Brown Grey Red Salt & Pepper White Other

Eye Color

---- Blue Brown Green Hazel Grey

Languages spoken

What is your political affiliation?

---- Conservative Liberal Middle of the Road Independent None Other Would rather not say

Do you smoke?

---- Yes, socially Yes, regularly No

Do you drink alcohol?

---- Yes, socially Yes, regularly No

Do you have pets?

---- Dog Cat Other

Do you have any pet allergies?

No Yes, dogs Yes, cats Yes, other

Your WhatsApp for feedback

How well do you speak English?

---- English — fluent English — Intermediate English — basic English — none

Which other languages do you speak, and what is your level?

How many children do you have, and what are their ages?

About Me

How would your close friends describe you — 3 words? And why?

Activities/Hobbies I enjoy

Walking Hiking Skiing Reading Movies Antiquing Dining out Cooking Gardening Spectator Sports Water Sports

Is there anything else you would like to share about yourself?

What matters most to you in life right now?

How do you spend your free time?

Who You're Looking For?

Partner's age range

Three most important qualities in a partner? Why its important for you right now?

Any deal-breakers? (children, religion, distance, habits)

Are you open to long-distance, relocation, or a partner from another country?

---- Yes, open to everything Open to relocation if the person is right My country only

In your own words — what does your ideal relationship look like?

Final Question

Are you open to working on yourself — understanding your patterns and growing with coach?

---- Yes, I want No, I'm not intersted Yes, i want it and matchmaking

Match Preferences

Preferred Gender

Female Male

Preferred Sexual Orientation

Straight Gay Lesbian Bisexual Other

Preferred Age Range

to

Preferred Relationship Status

Never Married Divorced Separated Widowed

Preferred Ethnicities

Asian Black Caucasian East Indian Hispanic/Latino Indian American Middle Eastern Multiracial Pacific Islander Other

Preferred Faith/Religion

Buddhist Catholic Chinese Traditional Christian East Asian Eastern Orthodox Hindu Indigenous Jewish Muslim Non-religious Protestant Sikh Spiritual Other

Preferred Education Level

High School Graduate Some College Associates Degree Technical Degree Bachelors Degree Graduate Degree J.D./M.D./PhD

Preferred Income

Less than $50k $50k - $100k $100k - $150k $150k - $250k $250k - $500k $500k - $1m $1m - $5m $5m + Would rather not share

Preferred Height (ft & in)

---- 3' 0" 3' 1" 3' 2" 3' 3" 3' 4" 3' 5" 3' 6" 3' 7" 3' 8" 3' 9" 3' 10" 3' 11" 4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" 7' 1" 7' 2" 7' 3" 7' 4" 7' 5" 7' 6" 7' 7" 7' 8" 7' 9" 7' 10" 7' 11" to ---- 3' 0" 3' 1" 3' 2" 3' 3" 3' 4" 3' 5" 3' 6" 3' 7" 3' 8" 3' 9" 3' 10" 3' 11" 4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" 7' 1" 7' 2" 7' 3" 7' 4" 7' 5" 7' 6" 7' 7" 7' 8" 7' 9" 7' 10" 7' 11"

Preferred Body Type

Athletic Average Curvy Fit Slender A few extra pounds

Preferred Hair Color

Bald Black Blonde Brown Grey Red Salt & Pepper White Other

Preferred Eye Color

Blue Brown Green Hazel Grey

Preferred Political Affiliation

Conservative Liberal Middle of the Road Independent None Other Would rather not say

Would you date someone who smokes?

Yes, socially Yes, regularly No

Would you date someone who drinks alcohol?

Yes, socially Yes, regularly No

Activities I want to share with my partner

Walking Hiking Skiing Reading Movies Antiquing Dining out Cooking Gardening Spectator Sports Water Sports

Describe your ideal partner

Preferred qualities in your ideal partner