| Name: | |
| Age: | |
| Phone: Home: | Cell: Work: |
| E-mail address: | |
| City: | Postal code: |
| House: Apt: |
| |
| In a relationship I: |
| Need and enjoy a continual display of affection from my partner both in public and in private |
| Need and enjoy ongoing affection from my partner |
| Enjoy being affectionate, but only in the right setting |
| Enjoy being affectionate occasionally |
| Have warm feelings towards my partner but don't always express my affection |
| |
| I feel the following way about my partner’s religious faith: |
| Being from the same religious faith is essential to me |
| Being from the same religious faith is important to me |
| I would marry someone from a different religious faith only if that person was willing to practice my religion |
| I would prefer to marry someone of my faith but it is not essential |
| Being from the same religious background is not important to me |
| |
| On an evening with someone special my preference is: |
| An evening of dancing followed by a stroll on the boardwalk
|
| Going out for a quiet candle lit dinner – just the two of us
|
| Going out for a nice dinner followed by a movie
|
| Joining some friends for dinner
|
| Going to a friend’s house to watch videos
|
| |
| When meeting new people: |
| I always find plenty of things to talk about |
| I am completely at ease making conversation |
| I am quite good at making conversation |
| I am somewhat reserved at the beginning |
| I am somewhat uncomfortable until I get to know the person better |
| |
| When I go out for the evening I: |
| Try to look my best and enjoy getting dressed up most often |
| Try to look my best but prefer to wear casual clothing most often |
| Care about the way I look but don’t always have to look my best |
| Don’t really think about the way I look |
| Wear whatever I feel like – appearances are not very important |
| |
| My attitudes are as follows: |
| I am somewhat left wing in my attitudes and am drawn to new ideas and opinions |
| I am very liberal in my opinions and always open to new ideas |
| I am quite liberal in my opinions and often open to new ideas |
| I am sometimes open to new ideas and sometimes believe that traditional ways are the best |
| I am fairly conservative in my opinions and often think traditional ways are best |
| |
| When the work day is over I: |
| Usually stay at work until quite late, to finish as much as possible |
| Often stay at work late or bring work home |
| Occasionally work late, but only when it is necessary |
| Rarely do work after hours |
| Never work after hours, I work hard enough during the day |
| |
| My level of physical fitness is as follows: |
| I have a major work out session every day |
| I get some exercise every day |
| I get some form of exercise a few times per week |
| I exercise occasionally |
| I rarely exercise |
| |
| When little things go wrong, I: |
| Get very upset and tense |
| Get irritated and sometimes up-tight |
| Get frustrated |
| Get frustrated for a few seconds but calm down quickly |
| Usually stay calm |
| |
| When friends are in a heated debate I: |
| Take control of the debate |
| Offer my opinion even if I’m not asked |
| Usually get involved in some way |
| Offer my opinion only if asked |
| Listen to both sides and try to stay out of it |
| Marital Status: | |
| Occupation: | |
| Income: | |
| How did you hear about us: | |
| |
| SUBMIT THIS FORM FOR YOUR TEST RESULTS AND A FREE DATE! |
