Questionnaire Form - Love and Life Architects

The Love Architects Questionnaire

Welcome to the Love Architects Online Assessment/Questionnaire. We ask that you complete the entire questionnaire as an introduction before we contact you for a phone interview.

All questions are required and must be completed before you may submit the form.

My Contact Information (1 of 5)

First Name:

Last Name:

Email Address:

Phone Number:

What are you looking for:
Dating
Committed Relationship
Marriage
Marriage and Children
Elite Bachelor/Bachelorette Consideration
Coaching/Other

About Me (2 of 5)

Your Age:

I'm a:
Male
Female

I am seeking a:
Male
Female

Have you ever been married?
No
Yes
If yes, how many times and when was most recent divorce finalized?

Do you have any children?
No
Yes
If yes, how many and what are their ages?

What is your occupation?

What is your favorite thing about yourself?

If you could change something about yourself, what would it be?

Who has inspired you most in life, and why?

What inspires you in life?

My Personality, Beliefs & Preferences (3 of 5)

Are you an introvert or an extrovert?
Introvert
Extrovert

How would you describe your beliefs?
Spiritual
Religious
Agnostic
None of the above

How would you describe your political orientation?
Very Conservative
Somewhat Conservative
Somewhat Liberal
Very Liberal
Independent
Not Important

Do you enjoy being indoors or outdoors most?
Indoors
Outdoors
Both Evenly

Do you believe in Soul Mates?
No
Yes

Are you an animal lover?
Cats Only
Dogs Only
Cats and Dogs Only
All Animals

My Lifestyle (4 of 5)

Are you a smoker?
No
Socially/ Occasionally
Yes

Do you drink Alcohol?
Never
Occasionally
Socially
Frequently
In Recovery

Upload a Photo (5 of 5)

Upload a recent photo

© 2009 Kai-len Love and Life Architects. All rights reserved. Kailen Rosenberg is a life coach, relationship expert and guide in spiritual growth; she is not a licensed therapist. Certified practitioners are brought in if a specific situation requires professional counseling.

810 East Lake Street, Wayzata, MN 55391, 952-544-5683

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