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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?		Education
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?