Your phone number (optional):
Date of birth 1
Date of birth 2
Are you under professional care?
Are you taking prescribed medication?
Are you afraid of being left alone?
Can you spend time by yourself?
- rather not
Self-assessment attributes (mark applicable items)
Please follow a scale of 1 to 10 (1 is low . . . 10 is extremely high)
to rate yourself for the following items.
Your sense of aggression:
Your sense of stress:
Your sense of commitment:
Your sense of confidence:
Your sense of physical health:
Your sense of spiritual health:
Your sense of balance:
openness to new concepts:
On the same scale, show how well you can concentrate on learning a new
Once you start on a project, continuity is important. Can you commit
half hour per day for your happiness?
Please mark ONE concept you feel at home naturally
What do you seek from a relationship? relationship.
If something else, please explain,
Do you understand the concept of feminine nature of spirituality?
Do you understand the concept of Karma?
Of the relationships based on gender, which ones you consider as more compatible?
During childhood who did you feel close to?
Add a comment re above
I confirm that I am providing this self-assessment, because
this relationship is very important to me
Please state what you would like to achieve for yourself.
Be proud that you have taken the first step!
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