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Black Love Pizza Party
Shop
T-Shirts
Hoodies
Black Love Is Dope
Crew Neck Sweat Shirt
Camp Black Love
Books, Posters & Prints
Accessories
About
Podcast
Coaching Session
Blog
Contact
Age
*
20-24
25-35
36-45
46-55
56-65
65 & Over
Sex
Male
Female
Nationality
Black
Hispanic
White
Asian
Native American
Middle Eastern
African
Caribbean
Other
Race (what's your other)
*
Income
*
$35,000 & Under
$35,000-$50,000
$50,000-$70,000
$70,000-$100,000
$100,000 & over
Relationship Status
*
Single
Divorced
Dating (less than a year)
Committed Relationship (1 year & over)
Married
Are You Employed?
*
Yes
No
Children
*
Yes
No
Who Raised You?
*
Mom & Dad
Mom
Dad
Adopted
Other
If Other (Who)
How Many Siblings
*
0
1
2
3
4
5
Siblings (More Than 5)
Family
*
I love my family.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My family loves me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I love my dad.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My dad loves me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I love my dad.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My mom loves me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I love my mom.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Single, Married & Relationship
*
Please answer all questions. If your single, married or in relationship check strongly disagree or disagree for other relationship questions.
I enjoy being single.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I enjoy being in a relationship.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I enjoy marriage.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Men
*
I love men.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand men.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I can communicate to men effectively.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Women
*
I love women.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand women.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I communicate effectively with women.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Race
*
Love has no color.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'll marry outside of my race.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I prefer to marry within my race. ethnic background & culture.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Sex
*
Sex is very important.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand my body sexually.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand my partners body sexually.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'm willing to learn more about my body sexually.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'm willing to learn more about my partners body sexually.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have a healthy view on sex.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Finances
*
My partner has to make more money than me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have to make more money than my partner..
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My partner and I can share financial responsibility.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
What do you want know about the opposite sex?
Do you remember the last person to hurt your heart or feelings?
*
Yes
No
How did they hurt you?
Are you healed?
How have you healed?
Thank you!