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Please complete our confidential questionnaire and a representative will contact you:
Name
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Last
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Sex:
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Male
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1) I love having people around me.
True
False
2) I would like a partner who is the life of the party.
True
False
3) I am a very affectionate person and long for the same.
True
False
4) I set goals in my life and strive to achieve them.
True
False
5) I am happiest when in love and don't like being alone.
True
False
6) I am open minded and wear my heart on my sleeve.
True
False
7) I am very emotional about love.
True
False
8) Respect is very important in a relationship.
True
False
9) It is important that my mate and I are on the same intellectual level.
True
False
10) It's important that my mate and I share the same cultural, ethnic and religious backgrounds.
True
False
Which of the following have you utilized to meet people? (check all that apply)
Night Clubs
Friends
Church
Relatives
Chance
Health Clubs
Which of the following make it a challenge to meet people? (check all that apply)
I'm not comfortable in the social scene.
I'm a single person with children.
I have a demanding career.
Let us know if you have any other comments.
