Fill out the questionnaire that pertains to your specific need.

 

Thank you for your time in completing this!

A. Dating and Relationships

 
Name
Name
Phone
Phone
Sex
Age Range
Education
Realationship status: *
3. I would date outside my race:
4. I tend to avoid commitment:
5. I would date for money rather than love: *
6. I enjoy going out and partying with friends: *
 

B. Image, Style and Fashion

Name *
Name
Phone
Phone
Sex:
Age Range:
Education:
4. New trends in society influence your style: *
5. Money plays a role in your style: *
6. Would you buy a brand of clothing solely because it is promoted by your favorite celebrity:
 

C. Fitness and Health

Name *
Name
Phone
Phone
Sex:
Age Range:
Education:
Children:
3. Close friends and family members exercise regularly and maintain a healthy diet: *
6. What do you see as a more important factor in weight loss?
8. Are you willing to make a long term commitment to a healthy lifestyle, as opposed to a short term solution for superficial reasons?