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Questionnaire - Palm and AssociatesPalm and Associates
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.