Congratulations on taking this exciting next step in your life! We know that this experience will be fun, private and effective.

Please take the time to complete this short questionnaire. It will help us get to know a little bit about you, and better understand the type of person you are looking for in a companion.

Once we receive your questionnaire, a member of the Introductions team will be in contact with you to arrange a private, no obligation consultation. Now relax and remember to answer from your heart. There are no right or wrong answers to any of these questions.

First, tell us a little about yourself...
First Name:	Last Name:
Street Address:	City: Zip Code:
Sex: Male    Female	Age:
Phone Best time to reach you:    AM   PM
E-Mail:
How did you hear about us:
Level of Interest: Very High: High: Medium: Low: Very Low: