QUESTIONAIRE FOR BUILDING A TRUE COMMUNITY

NAME

PHONE NUMBER

EMAIL ADDRESS

RESIDENTIAL ADDRESS

D.O.B.

RELATIONSHIP STATUS

ARE YOU LOOKING FOR A RELATIONSHIP PARTNER OR A BETTER ONE THAN THE ONE YOU HAVE NOW?

IF YOU ARE IN A RELATIONSHIP, ARE YOU SATISFIED?

PLEASE DESCRIBE THE TYPE OF RELATIONSHIP PARTNER YOU DESIRE

HOW CAN YOUR RELATIONSHIP BECOME BETTER OR OPTIMAL?

PLEASE DESCRIBE YOUR IDEAL RELATIONSHIP

WHAT ARE YOUR

NEEDS

DESIRES

SKILLS

TALENTS

RESOURCES

BUSINESSES

GOALS

HOW CAN WE BEST SUPPORT YOU IN REACHING ALL OF YOUR GOALS?

ARE THERE ANY EVENTS YOU DESIRE ADDED TO OUR CALENDAR OF EVENTS?

DR. NATURAL 718-783-3465  

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