Assisted Care Services

Name *

First

Last

Email *

Who do you live with?I live aloneWith roommatesWith parents

Height

Eye Color

Age

Are you vegan/vegetarian?YesNo

Do you drink?YesNoOccasionally

Where are you located?

Weight

Hair Color

Do you have pets?YesYesNo

Do you smoke?YesNoOccasionally

How long was your last relationship?Less than 6 months6 months - 1 year1 year - 2 years

What type of relationship are you looking for now?Casual/For FunCommitted RelationshipOnline/Virtual

Select all that apply

Is long distance ok?YesNo

Describe your favorite hobbies and interests:

Describe your taste in music:

Describe your taste in film and television:

Describe your taste in books and podcasts:

What are the most important qualities in a relationship?

Is there anything else I should know about you?

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