Intake Form
Full Name
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Birthdate
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How would you describe your gender?
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Woman
Man
Nonbinary
Other
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How tall are you?
How do you spend your days? What do you do for a living?
Where are you from? Where did you grow up?
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Where in town are you based? (Neighborhood name)
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What are your hobbies, interests, passions?
Who are you interested in dating?
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Women
Men
Nonbinary people
Open to all genders
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What kind of romantic relationship are you looking for?
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Something sweet for the summer
A special connection and commitment (a partner)
A sacred union (long-term partner, perhaps someone to build a future with, a 4lifer)
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What values do you hope to share with someone you're dating?
Is there anything else you'd like us to know about your preferences?
Email
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Phone Number
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Upload a photo of yourself
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Submit
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