Premiere Matchmaking Agency
Matchmaker Kimberly

Questionnaire

This one page questionnaire submits directly to the matchmaker’s inbox and will remain private and confidential. This form should take approximately 10-15 minutes to complete. 

Tell Us About Yourself:

Never MarriedSeparatedDivorcedWidowed
YesNo
YesNoMaybe




CaucasianAsianLatinoIndianAfrican AmericanMiddle EasternOther

AgnosticAtheistBuddhistCatholicChristianNot ReligiousJewishSpiritualOther
RepublicanDemocraticIndependentNot Political

Under $100K$100-150K$150-250K$250-500KOver $500K








YesNoOccasionally
ExcellentGoodFairPoor
YesNo
NeverRarelySocialModerateHeavy
YesNo

ActiveAdventurousAffectionateAmbitiousArgumentativeAthleticClean cutConservativeCreativeDevotedEasygoingEccentricEmotionalFlexibleGivingHigh EnergyHumorousIntellectualPlayfulMusicalOrganizedReliableRomanticSarcasticSexyShySimpleSocialSpontaneousTalkativeThoughtfulWittyWorldly
YesNo
YesNo

YOUR MATE






Under $100K$100K+$150K+$250K+$500K+Does Not Matter

Full Time CareerWorks Part TimeRetiredDoes Not Matter
YesNoMaybe

CaucasianAsianLatinoIndianAfrican AmericanMiddle EasternOther

AgnosticAtheistBuddhistCatholicChristianDoes Not MatterJewishSpiritualOther
YesNoMaybe
YesNoMaybe

By executing this questionnaire, you declare all of the information stated to be true and correct.

Ladies, after clicking the submit button below, don't forget to complete Step 2.