Dating Questionnaire
To be completed at the time of the client interview
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
Matchmaker
Client Name
First Name
Last Name
Referred by
First Name
Last Name
Age
Gender
Male
Female
Marital Status
Married
Divorced
Single
Widowed
Is seeking
Male
Female
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
What are some of your hard stops?
Things you will not tolerate
Current photo
Submit
Should be Empty: