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Client Profile

General Information
First Name Last Name
Gender Male Female Age
Height ft. in. Weight lbs.
Birthday Zodiac Sign
Birth Year    
Contact Information
Address City
State/Zip E-Mail Address
Home # Cell #
Work # Home Own Rent
Professional Information
Occupation Income
Background Information
Where did you grow up?


Ever been engaged? Yes No Been married? Yes No
Do you have kids? Yes No If YES how many?
  If YES how old?
  If YES how often are they with you?
Do you want kids? Yes No Would you date someone with children? Yes No
Personal Information
What are your passions?
Do you like Animals? Yes No Would you date someone who opposed your like/dislike of animals? Yes No
What is your religion? Do you have a religious preference? If so, what?
What is your ethnicity? Do you have an ethnic preference? If so, what?
Do you smoke? Yes No Would you date a smoker/non-smoker that opposed your habits? Yes No
When was your last long-term relationship?
Describe your last relationship? What went wrong? What were your troubles?
What about you are people most attracted to? What kind of men/women are you attracted to?
Which books are most meaningful to you and why?
What are your goals?
What are your pet peeves?
Is there any other information that you could tell me about yourself that might've been missed with the questions above?

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