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Questionnaire
ABOUT YOU
Name:
Age:
Address:
Tel Home:
Tel Work:
Mobile
e-mail
Marital Status
Choose
Single
Divorced
Widowed
Legally Separated
Number of Children
Height
Build
What is the best time to reach you?
Choose
Early morning
Mid morning
Midday
Early afternoon
Mid afternoon
Late afternoon
Early evening
Mid evening
Any time
Where did you hear about us?
Choose
Local paper
Recommendation
Browsing the internet
Newspaper
Magazine
When last meaningful relationship ended?
Choose
Less than a month
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
1 Year
More than 1 year
About your education:
Choose
Secondary School
College
University
Your employment?
Choose
Full Time
Part-time
Self Employed
Personal income
Your income:
Choose
£18-25,000
£25-40,000
£40-60,000
Over £60,000
What are your relationship goals?
Choose
Medium Term
Long Term
Marriage
Do you smoke?
Choose
Yes
No
Occasional
Social
Are you new to the area?
No:
Yes:
If yes, where from?
What encouraged you to fill in this questionnaire?
How long have you considered alternative ways of meeting people?
Top of page
ABOUT THE PARTNER YOU WOULD LIKE TO MEET
What age group do you prefer to meet?
From - To:
Doesn't matter:
Their Marital Status
Choose
Single
Divorced
Widowed
Legally Separated
Would you like to meet someone who has children?
Choose
Yes
No
It doesn't matter
Height preferred
What minimum educational background do you prefer?
Choose
Secondary
College
University
It doesn't matter
Their income:
Choose
£18-25,000
£25-40,000
£40-60,000
Over £60,000
Physical attributes
Would you meet a smoker?
Choose
Yes
No
Prefer not to
It doesn't matter
What interest(s) would you like to share with someone?
Cooking
Cultural
Dancing
Football
Health & Fitness
Motor Racing
Museums
Music
Outdoor Pursuits
Sport (General)
Theatre
The Arts
Travel
Water Sports
Press Ctrl to choose more than one
What qualities are you looking for in a potential partner?
