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Profile Form and Questionnaire

About you:

Name:
Address:
City:
State:
Zip:
Telephone:
Email address:
Age:
Astrological sign (if known):
Height:
Weight:
Eye color:
Hair Color:
Occupation:
Education:
Religion:
Relationship Status:
Do you have children? If so, please tell us about him/her
Do you Smoke?Yes     No
If so, how often?
Do you drink alcoholic beverages?Yes     No
If so, how often?
Do you exercise?
Do you go for regular medical check-ups?
Are you sexually active?
Is sex an important part of your relationship?
Are you financially secure?
Please list some of your hobbies:
How would you describe your sense of humor?
Which is your favorite season (spring, summer, fall, winter), and why?
Do you like to dance? If yes, what type of dance do you enjoy?
What type(s) of music do you enjoy?
What do you like to do for fun?
What is the last book you read?
What kinds of sports and exercises do you enjoy? (please circle all that apply)
Aerobics
Basketball
Cycling
Golf
Martial Arts
Soccer
Volleyball
Yoga
Auto Racing
Billiards/Pool
Dancing
Hockey
Running
Swimming
Walking/Hiking
Weightlifting
Baseball
Bowling
Football
Inline Skating
Skiing
Tennis/Racquet Sports
Other-Please list:
Which of the following describes your daily diet? (please circle)
Meat & Potatoes
Vegetarian/Vegan
Health Nut
Junk-food Junkie
All chocolate, all the time
Other
None of the above:
Do you have any pets? If so, please list:
How would you describe an ideal date?
Which would you prefer to do on a date? (Please choose one)
Dancing in a nightclub
Picnic in the park
Amusement Park
Dinner and a movie
Evening stroll on the beach
None of the above:
Who has been your most influential person in your life, other than your parents and why?
What are 3 things you are most thankful for?
Please choose from the list below all that best describe you:
Warm
Agreeable
Aloof
Impulsive
Frugal
Intelligent
Neat
Perfectionist
Uncomplicated
Communicative
Patient
Passionate
Over-Achiever
Show-off
Aggressive
Restless
Clever
Modest
Quarrelsome
Stable
Predictable
Compassionate
Content
Creative
Generous
Honest
Reliable
Caring
Vivacious
Independent
Persistent
Romantic
Dominant
Submissive
Cold
Energetic
Affectionate
Attractive
Humorous
Spontaneous
Intellectual
Sensual
Resilient
Genuine
Wise
Kind
Outspoken
Selfish
Ambitious
Lazy
Gregarious
Spiritual
Jealous
Loyal
Efficient
Sensitive
Disciplined
Liberal
Optimistic
Open
Bossy
Calm
Rational
Shy
Outgoing
Introverted
Arrogant
Adventurous
Organized
Witty
Artistic
Under-Achiever
Adaptable
Charming
Conservative
Competitive
Leader
Courageous
Opinionated
Stubborn
Trusting
Choose 4 descriptions below that your friends would say describe you.
Good
Spontaneous
Dependable
Ambitious
Quiet
Passionate
Listener
Fit
Romantic
Articulate
Genuine
Energetic
Modest
Warm
Creative
Rational
Intelligent
Funny
Respectful
Outgoing
Loyal
Easy-going
Hardworking
Perceptive
Affectionate
Optimistic
Spiritual
Generous
Thoughtful
Caring
Kind
Happy
Sweet
How would each of the following describe you:
 Not at AllSomewhatVery Much
Like to Joke
Enjoy work
Like Socializing with People
Like Reading
Physically Active
Able to Express Yourself
Religious Beliefs Important
Strive for Career Advancement
Can Converse With People I've Just Met.
You Think Outside the Box
You Are Well-Adjusted
You Take Time to "Veg Out"
You are Artistic
You See Humor in Everyday Life
You Care About Your Appearance
Like to Work Out
Can Make Others Laugh
You are Emotionally Stable
Easily irritated
Like to Be Pampered
Please select whether the statement pertains to you (True) or not (False)
True
False
Like many different types of recreational activities
True
False
You iron your jeans
True
False
Drive faster than the posted speed-limit
True
False
Store clerk gave too much change, do you keep it without saying anything
True
False
Like to come out ahead
True
False
Worry about work-related issues
True
False
Waste time when I should be working
True
False
Have raised your voice in anger
True
False
You care what people think of you
True
False
You make fun of people behind their backs
True
False
You are envious of other people's possessions
True
False
You're always even-tempered

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