Relationship Goals Intake Form
Please complete this form to help us understand your relationship priorities and preferences.
Full Name
*
First Name
Last Name
Age
*
Gender
Male
Female
Non-binary
Prefer not to say
Other
Current Relationship Status
*
Please Select
Single
In a relationship
Engaged
Married
Separated
Divorced
Widowed
What are your top three relationship goals?
*
What qualities do you value most in a partner?
*
Which aspects of a relationship are most important to you?
*
Trust
Communication
Shared values
Emotional support
Physical intimacy
Financial stability
Personal growth
Other
How do you prefer to communicate with your partner?
In-person conversations
Phone calls
Text messages
Video calls
Other
What are your non-negotiables or dealbreakers in a relationship?
*
Where do you see yourself in five years regarding relationships?
Submit
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