Thank you for your interest!

Please fill out our brief initial Registration Form below.  We value your privacy.  All information submitted is confidential and for Straight to the Heart purposes only.

Your Name (required)

Your Email (required)

Birthdate please use the format of YYYY-MM-DD (required)

Address (required)

City/State (required)

Phone (required)

Profession (required)

What is your marital status? (required)

Do you have Children, if so, what is your custody arrangement?

What is your highest level of education?

What are your 3 critical requirements in a match? (required)

What religion, if any do you practice? (required)

Do you smoke?

Do you drink?

Do you use marijuana?

What is the distance you are willing to travel to date someone? (required)

If you met the right person would you be willing to relocate?

What is the best time and day to contact you? (required)

What is your height? (required)

What is your weight? (required)

Please upload a recent photo of yourself (limit 3mb) (required)

Please upload a recent full body photo picture of yourself (limit 3mb) (required)

What do you feel have been your obstacles in finding someone? (required)

Tell me a little about yourself (required)

Describe the type of man you feel that would best compliment you. (required)

How did you hear about Straight to the Heart