Name *

First Name

Last Name

Phone *

In case we can't reach you by email first.

(###)

###

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What are your preferred pronouns?

They / them

She / her

He / him

How old are you? *

20 or younger

21 to 29

30 to 39

40 to 49

50 to 59

60 to 69

70 or older

What's your current relationship status? *

Common law

Divorced

Married

Separated

Single

Widowed / widower

I date: *

Men only

Women only

Both men and women

Pansexually (Meaning you are sexually attracted to many types of people and don't care about gender identitiy.)

How did you learn about this service? *

Friend or family member

Instagram or other social media

Pinterest

Podcast

Random Google search