MY LOVE PROFILE FORM (PART 2)

Email:

First Name:

Middle Name:

Last Name:

Hair Color:
Blonde Brown Red Black Other

If you selected 'other' - please clarify:

Eye Color:
Blue Brown Green Other

If you selected 'other' - please clarify:

Do you have any conditions, medical or otherwise, that may affect the matchmaking process (this can include STDs, restrictions, allergies, disabilities or special needs)?:
Yes No Other

If you selected 'yes' or 'other' - please clarify (Optional):

Will you date an individual that may have known conditions or restrictions, medical or otherwise (this can include STDs, restrictions, allergies, disabilities or special needs)?:
Yes No Other

If you selected 'yes' or 'other' - please clarify (Optional):

Enjoyments/Hobbies:

Vices: (Alcohol, Smoking, Recreational Drug use, etc.):

Are you the Life of the Party or a Wallflower?:
Life of the Party Wallflower

Are you a sensitive person?:
Yes No

Are you good at following rules and guidelines?:
Yes No

Do you like our current President?:
Yes No Other

Please include the President's name, and if you selected 'other' - please clarify:

Five Favorite books, movies, and/or TV shows:

Favorite type(s) of music:

Are you an Omnivore, Vegetarian, Carnivore, Pescatarian, etc.? Favorite foods?:

Do you have pets?
Yes No

If you selected 'yes' - what type?:

Tell us about you! What are some of your positive and negative traits?:

Who are your three 'celebrity crushes'?:

When was your last relationship?:

If separated or divorced, how is your relationship with your 'ex'?:

Describe your last 'ex':

What are your five 'must-haves' in a relationship?:

What are your five 'deal breakers' in a relationship?:

Tell us all about your (Potential or Existing) mate - physically, mentally and emotionally:

Dating career preferences (homemaker, student, executive, entrepreneur, etc.):

Dating education preferences (you can select multiple):
High-School Associates Bachelors Masters PhD Doctorate No-Preference

Dating personality preferences (extrovert, introvert, etc.):

Dating income level requirements (you can select multiple):
Under $25,000 $25,000-$50,000 $50,000-$100,000 $100,000-$150,000 $150,000-$250,000 $250,000-$1,000,000 Over $1,000,000 Over $5,000,000 No Preference

Dating height range:
Minimum Height: Maximum Height:

Will you date someone that lives more than two hours from you?
Yes No

Are you willing to relocate for Love?
Yes No

Please list all of the dating sites you have used:

What Services are you most interested in (you can select multiple):
Love Introductions/Matchmaking Date Coaching Relationship Coaching Online Dating Profile Management Ex Services Joining our Dating Lovebase

Why do you want to work with us?:

Your Facebook link:

Elite Matchmaking Nationwide

The Best Matchmaking Services,
Date & Relationship Coaching, and Online Dating Profile Refinement

Ready to be matched? Help us help you… by sharing a little more! Please take a few more moments and give us some more “YOU” details…!

MY LOVE PROFILE FORM (PART 2)