EM Consult

1. Basic Information:
Your Name:*
Address (es): (required)*
[If you have more than one residence, please list all cities where you spend significant time. Which city do you consider your primary residence?]
Phone*
✓ Valid number ✕ Invalid number
Email*
Age and birth date (please be honest here, this is totally confidential):
Weight and height (please be honest here, this is totally confidential):
How did you hear about Exclusive Matchmaking and Susan Trombetti?
Religion:
Ethnicity or Nationality:

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Marital Status: (indicate one)
- Never Married
- Divorced
- Widowed
If Divorced (how many times?):
*please use this space to describe relevant details about marital status (i.e., If divorced or widowed, how long? What happened?)
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:

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2.Describe yourself in detail:
Your personality strengths/weaknesses
Your interests:
Your Physical appearance:
(**Also, if you have an online dating profile, please copy it into an email and send it to me with the photos you are using online, or send me your username and site and I will try to look it up)
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?
It's very important to think this through so we can suggest services that work for your budget if possible.
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?

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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.

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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.
Comments
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1. Basic Information: