LastFirst Questionnaire Welcome to the LastFirst Questionnaire. To ensure that your answers are submitted properly, please do not hit the Enter key when providing answers, as this will submit the form. Thank you!Client IDFirst NameLast NameAgeBirthdate Phone NumberYour EmailMailing Address Street & Apartment City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Social Media HandlesHow did you hear about us?PHYSICALHeightHair ColorBlackBlondeBlonde/GrayBlonde/Salt and PepperishBlondish/BrownBrownDark BlondeDark Brown/GrayGrayLight BrownNoneSalt and PepperEye ColorBlackBrownHazel BrownChestnut Brown Crystal BlueSteel BlueGrayGreenBottle GreenEmerald GreenForest GreenGrass GreenVioletBody TypeThinAverageAthleticCurvyOtherAre you physically active? Do you participate in any sports/physical activities? If so, how often? Please describe.Do you have any dietary restrictions?Do you have any tattoos or piercings?What would you consider your most valuable attribute?What do you like to do in your free time?EDUCATION & EMPLOYMENTName of Schools/Colleges Attended & Year GraduatedOther Relevant Degrees?Profession & Brief DescriptionEmployer & Professional TitleHow long have you worked there?If less than 2 years, where did you work before?BACKGROUND & VALUESWhat ethnicities best describe you?Marital StatusNever MarriedSeparatedDivorcedWidow/WidowerDo you have any siblings?If so, how many? What number child are you?Where did you grow up?What are some of your favorite places?What countries have you visited?Do you speak any other languages?Do you have citizenship in any other country?Are your parents still married?If not, how old were you when they divorced and did they remarry?Describe your relationship with your mother.Describe your relationship with your father.What do your mother and father do for a living?Do you have children?YesNoIf so, what are their ages?Do you want children?How important is giving birth to your own children (on a scale of 1-10)? Please explain.What is your faith?ChristianJewishMuslimHinduAgnosticAtheistOtherWould you describe yourself as religious or spiritual? Please explain.Describe your political views.Do you have more male or female friends?How often do you drink?Drink of Choice?Do you smoke?Do you have pets? If so, what kind?Are you open to having pets? If so, what kind?ABOUT YOUFor a first date, do you prefer drinks or dinner?Describe Your Last RelationshipWhat is your greatest accomplishment in life?What are five things you can’t live without? Please explain.Please share an embarrassing moment from your life.What is your favorite book and why?What is your favorite movie/TV Show and why?If you could have a dinner party with any five people, living or dead, who would you invite and why?What is your most treasured memory?Do you ‘eat to live’ or ‘live to eat’?If you could be any country, which one would you be and why?What is your ‘walk-out’ song?In the romance department, where do you see yourself in three years?Anything else about yourself you would like to share?GETTING TO KNOW YOUR MATCHTypically, what is your type?What is your dating age range (youngest to oldest)?How important is your match’s height? Please be specific.Ethnicity?Religion?Are you open to embracing a different religion?Level of education?Any other spoken languages?Marital Status?Never MarriedDivorcedWidow/WidowerNo PreferenceSmoker?NoOccasionallyCigar AficionadoRegularlyNo PreferenceAlcohol?NeverModeratelySociallyRegularlyNo PreferenceDo you have any occupational preferences?Do you have a preference where he or she resides?Do you care if your partner already has children?What are the top three attributes you must have in a lifetime partner?What activities might you enjoy doing with your match?Do you have any concerns or questions about your partner's marital or family history?Any other comments or preferences? Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
