Dating Status Declaration Form
Please provide your current dating status and relevant context. All information is collected respectfully and confidentially.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Woman
Man
Non-binary
Prefer not to say
Other
Current Dating Status
*
Single
Casually Dating
In a Relationship
Engaged
Married
Separated
Divorced
Widowed
Other
How long have you been in this status?
*
Please Select
Less than 1 month
1-6 months
6-12 months
1-3 years
More than 3 years
Are you open to new relationships?
*
Yes
No
Unsure
Preferred Relationship Type
*
Long-term/Committed
Casual
Friendship
Open to possibilities
Other
Preferred Communication Methods
*
Text Message
Phone Call
Video Call
In Person
Other
What do you value most in a partner?
*
Honesty
Sense of Humor
Kindness
Shared Interests
Ambition
Emotional Intelligence
Other
Anything else you’d like to share about your dating status or preferences?
Submit
Should be Empty: