General Information
First Name
*
Last Name
*
Email
*
Phone
*
Date of birth
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Gender
*
----
female
male
Location
*
Photo
*
How did you hear about us?
*
----
Google
Referral
Event
Friend/Colleague
DatehimATX/Facebook
Instagram
LinkedIn
Word of Mouth
About me
*
Marital status
----
Divorced
Married
Never Married
Separated
Single
Widowed
How long have you been single?
Ethnicity
*
----
African-American
Asian
Asian Indian
Black
Caucasian
Chinese
East Indian
Eurasian
Hispanic/Latino
Middle Eastern
Multi-Ethnic
Native American
Other
Religion
*
----
Agnostic
All
Atheist
Buddhist
Christian (Catholic)
Christian (Other)
Christian (Protestant)
Free Thinker
Hindu
Jewish
Muslim
Other
Pagan & Earth-Based
Spiritual, not religious
Taoist
Unitarian Universalist
If you are religious, please describe how you practice your faith.
Political view
----
Conservative
Liberal
Moderate
Other
Please add any comments about political ideologies or preferences in a match.
Occupation
*
Annual income
----
$100,001 to $150,000
$100,001 to $250,000
$150,001 to $200,000
$1M to $3M
$200,001 to $250,000
$250,001 to $500,000
$50,001 to $75,000
$500,001 to $1M
$75,001 to $100,000
Less than $50,000
More than $20M
More than $3M
Eye color
----
Black
Blue
Brown
Green
Grey
Hazel
Hair color
----
Auburn
Bald
Black
Blonde_x000d_
Blue
Brown
Grey
Mixed
Other
Red
Salt & Pepper
White
Height
----
91cm - 3' 0"
92cm - 3' 0"
93cm - 3' 1"
94cm - 3' 1"
95cm - 3' 1"
96cm - 3' 2"
97cm - 3' 2"
98cm - 3' 3"
99cm - 3' 3"
100cm - 3' 3"
101cm - 3' 4"
102cm - 3' 4"
103cm - 3' 5"
104cm - 3' 5"
105cm - 3' 5"
106cm - 3' 6"
107cm - 3' 6"
108cm - 3' 7"
109cm - 3' 7"
110cm - 3' 7"
111cm - 3' 8"
112cm - 3' 8"
113cm - 3' 8"
114cm - 3' 9"
115cm - 3' 9"
116cm - 3' 10"
117cm - 3' 10"
118cm - 3' 10"
119cm - 3' 11"
120cm - 3' 11"
121cm - 4' 0"
122cm - 4' 0"
123cm - 4' 0"
124cm - 4' 1"
125cm - 4' 1"
126cm - 4' 2"
127cm - 4' 2"
128cm - 4' 2"
129cm - 4' 3"
130cm - 4' 3"
131cm - 4' 4"
132cm - 4' 4"
133cm - 4' 4"
134cm - 4' 5"
135cm - 4' 5"
136cm - 4' 6"
137cm - 4' 6"
138cm - 4' 6"
139cm - 4' 7"
140cm - 4' 7"
141cm - 4' 8"
142cm - 4' 8"
143cm - 4' 8"
144cm - 4' 9"
145cm - 4' 9"
146cm - 4' 9"
147cm - 4' 10"
148cm - 4' 10"
149cm - 4' 11"
150cm - 4' 11"
151cm - 4' 11"
152cm - 5' 0"
153cm - 5' 0"
154cm - 5' 1"
155cm - 5' 1"
156cm - 5' 1"
157cm - 5' 2"
158cm - 5' 2"
159cm - 5' 3"
160cm - 5' 3"
161cm - 5' 3"
162cm - 5' 4"
163cm - 5' 4"
164cm - 5' 5"
165cm - 5' 5"
166cm - 5' 5"
167cm - 5' 6"
168cm - 5' 6"
169cm - 5' 7"
170cm - 5' 7"
171cm - 5' 7"
172cm - 5' 8"
173cm - 5' 8"
174cm - 5' 9"
175cm - 5' 9"
176cm - 5' 9"
177cm - 5' 10"
178cm - 5' 10"
179cm - 5' 10"
180cm - 5' 11"
181cm - 5' 11"
182cm - 6' 0"
183cm - 6' 0"
184cm - 6' 0"
185cm - 6' 1"
186cm - 6' 1"
187cm - 6' 2"
188cm - 6' 2"
189cm - 6' 2"
190cm - 6' 3"
191cm - 6' 3"
192cm - 6' 4"
193cm - 6' 4"
194cm - 6' 4"
195cm - 6' 5"
196cm - 6' 5"
197cm - 6' 6"
198cm - 6' 6"
199cm - 6' 6"
200cm - 6' 7"
201cm - 6' 7"
202cm - 6' 8"
203cm - 6' 8"
204cm - 6' 8"
205cm - 6' 9"
206cm - 6' 9"
207cm - 6' 9"
208cm - 6' 10"
209cm - 6' 10"
210cm - 6' 11"
211cm - 6' 11"
212cm - 6' 11"
213cm - 7' 0"
214cm - 7' 0"
215cm - 7' 1"
216cm - 7' 1"
217cm - 7' 1"
218cm - 7' 2"
219cm - 7' 2"
220cm - 7' 3"
221cm - 7' 3"
222cm - 7' 3"
223cm - 7' 4"
224cm - 7' 4"
225cm - 7' 5"
226cm - 7' 5"
227cm - 7' 5"
228cm - 7' 6"
229cm - 7' 6"
230cm - 7' 7"
231cm - 7' 7"
232cm - 7' 7"
233cm - 7' 8"
234cm - 7' 8"
235cm - 7' 9"
236cm - 7' 9"
237cm - 7' 9"
238cm - 7' 10"
Weight
----
20kg - 44lbs
21kg - 46lbs
22kg - 48lbs
23kg - 50lbs
24kg - 52lbs
25kg - 55lbs
26kg - 57lbs
27kg - 59lbs
28kg - 61lbs
29kg - 63lbs
30kg - 66lbs
31kg - 68lbs
32kg - 70lbs
33kg - 72lbs
34kg - 74lbs
35kg - 77lbs
36kg - 79lbs
37kg - 81lbs
38kg - 83lbs
39kg - 85lbs
40kg - 88lbs
41kg - 90lbs
42kg - 92lbs
43kg - 94lbs
44kg - 97lbs
45kg - 99lbs
46kg - 101lbs
47kg - 103lbs
48kg - 105lbs
49kg - 108lbs
50kg - 110lbs
51kg - 112lbs
52kg - 114lbs
53kg - 116lbs
54kg - 119lbs
55kg - 121lbs
56kg - 123lbs
57kg - 125lbs
58kg - 127lbs
59kg - 130lbs
60kg - 132lbs
61kg - 134lbs
62kg - 136lbs
63kg - 138lbs
64kg - 141lbs
65kg - 143lbs
66kg - 145lbs
67kg - 147lbs
68kg - 149lbs
69kg - 152lbs
70kg - 154lbs
71kg - 156lbs
72kg - 158lbs
73kg - 160lbs
74kg - 163lbs
75kg - 165lbs
76kg - 167lbs
77kg - 169lbs
78kg - 171lbs
79kg - 174lbs
80kg - 176lbs
81kg - 178lbs
82kg - 180lbs
83kg - 182lbs
84kg - 185lbs
85kg - 187lbs
86kg - 189lbs
87kg - 191lbs
88kg - 194lbs
89kg - 196lbs
90kg - 198lbs
91kg - 200lbs
92kg - 202lbs
93kg - 205lbs
94kg - 207lbs
95kg - 209lbs
96kg - 211lbs
97kg - 213lbs
98kg - 216lbs
99kg - 218lbs
100kg - 220lbs
101kg - 222lbs
102kg - 224lbs
103kg - 227lbs
104kg - 229lbs
105kg - 231lbs
106kg - 233lbs
107kg - 235lbs
108kg - 238lbs
109kg - 240lbs
110kg - 242lbs
111kg - 244lbs
112kg - 246lbs
113kg - 249lbs
114kg - 251lbs
115kg - 253lbs
116kg - 255lbs
117kg - 257lbs
118kg - 260lbs
119kg - 262lbs
120kg - 264lbs
121kg - 266lbs
122kg - 268lbs
123kg - 271lbs
124kg - 273lbs
125kg - 275lbs
126kg - 277lbs
127kg - 279lbs
128kg - 282lbs
129kg - 284lbs
130kg - 286lbs
131kg - 288lbs
132kg - 291lbs
133kg - 293lbs
134kg - 295lbs
135kg - 297lbs
136kg - 299lbs
137kg - 302lbs
138kg - 304lbs
139kg - 306lbs
140kg - 308lbs
141kg - 310lbs
142kg - 313lbs
143kg - 315lbs
144kg - 317lbs
145kg - 319lbs
146kg - 321lbs
147kg - 324lbs
148kg - 326lbs
149kg - 328lbs
Body type
----
A few extra pounds
Athletic
Average
Curvy
Fit
Large
Petite
Slender
If so, what are their ages?
Do you want children?
----
I definitely DO NOT want to have kids
Maybe, I am not sure
Yes, I definitely want to have
Education
----
A Levels & Below
Advanced Diploma
Associates Degree
Bachelor's Degree
Diploma
Graduate Degree
High School
Junior College & Below
Masters Degree
PhD & Above
Polytechnic
Professional Qualification
Some College
University name
Undergraduate school
Major in
Minor in
Graduate school degree received
Hobbies
Exercise habits
----
A few times a month
A few times a week
Every day
Never or very infrequent
Once a month
Once every 3 months
Smoking habits
----
Light / Social
No
Yes
Drinking habits
----
Light / Social
No
Yes
Relationship expectations
Past relationship comments
Describe longest relationship
Geographic restrictions due to divorce?
What city and state did you grow up in?
What animals have you owned in the past?
Allergic to:
Dietary restrictions
Vegetarian?
----
Yes
No
Favorite restaurant
Languages fluent
Favorite travel destinations
Parents still alive?
----
Yes
No
Parent occupations
Siblings?
----
Yes
No
How often do you speak/visit your family?
Family importance
Introvert extrovert score
Additional Hobbies
What makes you a good partner?
What are some things you are working on personally?
What are your personal goals in five to ten years?
Can you pass a drug test? If not, why?
What ethnicities are you open to dating?
What part of town do you live in?
What other cities have you lived in as an adult?
Do you like to watch sports? If so what are your favorite teams?
Do you snow ski?
Do you play tennis?
Do you like yoga?
Do you like to play golf?
Do you like to scuba dive?
Do you like aquatic activities? If so, which ones?
Do you like to dance? If so, what kind?
Who are your favorite music artists?
What are some of your favorite movies?
What are some of your favorite TV/Netflix shows?
Do you own or rent?
Are you okay with someone who hunts or is a gun owner?
Who are some of your favorite authors?
Do you have any tattoos? If so, where? Are they visible?
Do you have any piercings? If so, where?
What is your favorite quote?
Meyers Briggs Type
Are you ok with an occasional cigar smoker?
If you have tattoos or piercings, are they visible while wearing business casual attire?
Do you believe in astrology?
Instagram handle:
Match Preferences
Preferred Gender
*
female
male
Preferred Age Range
*
to
Age Flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Preferred marital status
Divorced
Married
Never Married
Separated
Single
Widowed
Marital status flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Preferred ethnicity
*
African-American
Asian
Asian Indian
Black
Caucasian
Chinese
East Indian
Eurasian
Hispanic/Latino
Middle Eastern
Multi-Ethnic
Native American
Other
Ethnicity flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Preferred religion
*
Agnostic
All
Atheist
Buddhist
Christian (Catholic)
Christian (Other)
Christian (Protestant)
Free Thinker
Hindu
Jewish
Muslim
Other
Pagan & Earth-Based
Spiritual, not religious
Taoist
Unitarian Universalist
Religion flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Preferred political view
Conservative
Liberal
Moderate
Other
Political view flexibility
----
Not flexible
Very flexible
Moderately flexible
Preferred body type
A few extra pounds
Athletic
Average
Curvy
Fit
Large
Petite
Slender
Body type flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Match has children flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Match wants to have children
I definitely DO NOT want to have kids
Maybe, I am not sure
Yes, I definitely want to have
Preferred education level
A Levels & Below
Advanced Diploma
Associates Degree
Bachelor's Degree
Diploma
Graduate Degree
High School
Junior College & Below
Masters Degree
PhD & Above
Polytechnic
Professional Qualification
Some College
Education level flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Preferred drinking habits
Light / Social
No
Yes
Drinking habit flexibility
----
Not Flexible
Moderately Flexible
Extremely Flexible
Ideal qualities in a match
Key values
Deal breakers
Distance willing to travel
Submit