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printable fax survey

Online Survey
Qualification & Consent - Step 2


If you answer "yes" to any of the following questions, take this opportunity to fill out the remainder of this survey and substitute chance with choice!

For WOMEN

Are you tired of all the wrong men approaching you, and having to say "no thank you"; and the man you would like to meet never approaches?

Yes     No

Do you feel safe with the conventional methods of meeting men?

Yes     No
For MEN

Have you ever seen someone that you were attracted to, but wondered "How can I approach" without it sounding like a "pick up" line?

Yes     No

Are you frustrated with the games you have to play to try to meet someone?

Yes     No
For MEN & WOMEN

Have you been meeting people who, in the beginning, seem to be everything you want, then you discover within six months to a year that they are a totally different person?

Yes     No

Are you too busy, and/or do not like the 'bar scene", but would really like to meet someone special?

Yes     No

Privacy and Confidentiality
Protection of your information and confidentiality agreement: When you register to use the services of The Relationship Company, you will be asked for some general identifying information which will enable us to provide you with an individualized service. We gather contact information (like your email address), demographic information (like your city of residence or age). We may share some of this information for our own research purposes with our professional advisors or consultants, however the information shared will be limited to unidentifiable demographic information shared under cover of a confidentiality agreement.

This is an adult service. By selecting to continue you acknowledge and confirm that you are 18 years of age or older. Additional Information regarding your privacy please read our [privacy agreement].

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