Love❤Ish Dating Game Questionnaire

Contestant Questionnaire

To be completed at the time of the client interview
Date*

MonthDayYear
Contestant Name*

First NameLast Name
Referred by

First NameLast Name
Age*
What is your Zodiac Sign
Gender*

MaleFemale
Marital Status*

MarriedIn a RelationshipDivorcedSingleWidowed
Number of Children
Occupation
Is seeking*

MaleFemale
Is seeking age range of*
What are some important qualities you seek in a mate? *
Include age, personality traits, children, religion, income, and hobbies
Tell us something about you?*
Personality traits, children, religion, income, and hobbies
Tell us about your last marriage/ relationship?*
# of times married, length of last relationship, why did it end, still communicating
What are some of your challenging personality traits?*
Traits your mate may think is difficult to handle
What are some things you would alter regarding your current situation?*
Including children, job, education, car, family, residence, relationships
What are some things you are willing to compromise for the right person?*
Height, education, appearance, income, children, religion
List 5 likes about Men/Women*
Things you like about men\women
List 5 Dislikes about Men/Women*
Things you dislike about men\women
List your top 3 pet peeves*
Things that irritate you
Current photo*
What type of relationship are you looking for

Booty callEntanglementCompanionshipRelationshipMarriage
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty:

Contestant Questionnaire