EM Consult

Consultation Form

Marital Status:
Never Married
Divorced
Widowed

If Divorced (how many times?):

Do you have children? (indicate one)
No
Yes

If no, do you want children?

If yes, what are their ages/genders?

Education: please list all colleges/graduate schools attended, included years graduated:

Career overview (general description, both past and present jobs):

Estimated annual income:

Estimated net worth:

Please describe your current job in more detail, including your typical work hours:

Your personality strengths/weaknesses:

Your interests:

Your Physical appearance:

What type of woman / man are you looking for?

What have you done to meet people in the past? Which of those activities has been the most successful?

How much do you think matchmaking costs?

What is your budget for matchmaking?

Matchmaking can be expensive, so why not date online with a different strategy?

If you have read any self-help dating books, please list here any titles that you found particularly helpful, and explain why.

If you have worked with another dating coach or matchmaker in the past, please list the name of that person or service here, and describe your experience.

How many new single women/men do you meet each month on average? How many dates do you have in an average month?

Describe the qualities of the typical eligible women/men you meet:

What do you think is your biggest obstacle to finding your mate?

Why do you think you are single now? What has actually prevented you thus far from finding the right person? {Please think carefully about this…}

What would you predict that your friends and family would tell me about why they think you haven’t met the right person? List each person and give a basic reason you think each friend would tell me.

Relationship #1

Date and Duration:

General description of him/her:

Why didn’t this relationship work out?

Relationship #2

Date and Duration:

General description of him/her:

Why didn’t this relationship work out?

Are you now (or have even been) in professional therapy? If so, please describe the central issues that you work (ed) on.

Please describe any health issues or limitations that you have (or had), and any medication you are currently taking.

Please describe any other relevant information I should know about you and your situation:

Please list in order your top three goals for your initial consultation: what dating or relationship issues do you most need my help with? The time does go by quickly, and I want to make sure I answer your most pressing questions.