PART ONE: BASICS
Name

Age

Height

Weight

Location

Tattoos/Piercings

(please describe in detail)

PART 2: NOW
Are you? (please check all that apply)
arrogant
boring
cuddly
dominant
eccentric
fat
fun
gay
goofy
healthy
honest
inconsiderate
insecure
jealous
liar
macho
mature
moral
neat
open
organized
outgoing
religious
republican
respectful
responsible
sensitive
sweet
vegan
witty


PART 3: OCCUPATION
Does your occupation require you to work during the day?
Yes No
Does your occupation require you to work during the night?
Yes No
Does your occupation require you to work weekends?
Yes No
Does your occupation involve a g-string of any kind?
Yes No
Is your occupation legal in all 50 states?
Yes No

PART 4: HABITS
Do you drink?
Yes No
Smoke?
Yes No
Floss?
Yes No
Use pot?
Yes No
Cocaine?
Yes No
Condoms?
Yes No
Ecstasy?
Yes No
Heroin?
Yes No
Ketamine?
Yes No
Methamphetamine?
Yes No
PCP?
Yes No
Other illegal, mind altering substances?
Yes No
Do you take vitamins?
Yes No
Steroids?
Yes No
Perscription drugs?
Yes No
Without a perscription?
Yes No
If Yes, Please explain:

Please list all substances currently in your bloodstream:

PART 5: FAMILY
Have you ever been married?
Yes No
If yes, Have you since been divorced?
Yes No
If no, Please explain:

Number of children you have fathered:

If more than 1, do they have the same mother?
Yes No
If no, please explain:

How often do you call your mother?

If more than once daily, please explain:

PART 6: STUFF
Do you currently have...
a valid driver’s license?
Yes No
a registered and insured vehicle with 4 wheels?
Yes No
a cat?
Yes No
a porcelain tea set?
Yes No
a pair of trousers that hang below your crotch?
Yes No
a spouse?
Yes No
a spatula?
Yes No
a unicycle?
Yes No
a bible?
Yes No
a bank account?
Yes No
a belt?
Yes No
a porn collection?
Yes No
a hangover?
Yes No
a girlfriend?
Yes No
a pink shirt?
Yes No
non-eatable items in your refrigerator?
Yes No
a Miley Cyrus CD?
Yes No
a blow-up doll?
Yes No
a gym membership?
Yes No
a foreskin?
Yes No
a computer running windows vista?
Yes No
clothing with rhinestones?
Yes No
a sexually transmitted disease?
Yes No
an iPhone?
Yes No
an accent?
Yes No
an ex-fiancee?
Yes No

PART 7: LIFE
Most important thing in my life is....

The best thing on TV is....

In the car, I listen to....

Sometimes when no one is looking, I....

PART 8: FANTASY
Please answer the following questions honestly.
How often do you fantasize about the following?

Sex with 2 people or more:
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Rape:
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

S&M:
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Transvestites:
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Other men:
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Cross Dressing
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Roleplay
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Urine/Feces/Enemas/Diapers or anything related
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Children
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Animals
Never
Thought about it once or twice
Think about it once in a while
Think about it often
Think about it daily

Do any of the following turn you on?