Questionaire

Following questions will help us to serve you better.  Your privacy will be respected. Please see our Privicy Policy.

Fields with * are mandatory.


Personal Details:

Title		Mr Mrs Ms		Favourite activities:
*First Name:				Fishing:
*Surname:				Scuba diving:
*Street:				Boating:
*City:				Kayaking:
*Postcode:				Kitesurfing
*State:				Swimming in ocean:
*Country:				Going to the beach:
*Phone:				Horse riding:
Fax:				Tennis:
Mobile:				Golfing:
*Email:				Ten Pin bowling:
Occupation:				Sightseeing:
Education:				Scenic flights:
Rel.Belief:				Parachuting:
Height:				Yoga:
Weight:				Pilates:
Skin Type:				Other:
Hair Color:
Allergies:

For following questions, please choose the numbers between 0 - 10 0-3 = low, 4-6 = medium, 7-10 = high.
I am happy with my weight:		0 1 2 3 4 5 6 7 8 9 10		Food and Drinks:
I feel that I am fit:		0 1 2 3 4 5 6 7 8 9 10		Healthy food:
I regularly exercise:		0 1 2 3 4 5 6 7 8 9 10		Fast food:
I am happy with my environment:		0 1 2 3 4 5 6 7 8 9 10		Vegetarian food:
I am happy with my lifestyle:		0 1 2 3 4 5 6 7 8 9 10		I like to eat:
I like nature:		0 1 2 3 4 5 6 7 8 9 10		Beef:
I like animals:		0 1 2 3 4 5 6 7 8 9 10		Pork:
				Lamb:
If a fairy would grant you 3 wishes, what would you wish for:				Chicken:
First wish:				Other meats:
Second wish:				Ocean fish:
Third wish:				Freshwater fish:
Personal Perception:				Prawns:
Inquisitive:		1 2 3 4 5 6 7 8 9 10		Shellfish:
Extrovert:		1 2 3 4 5 6 7 8 9 10		Other seafood:
Adventurous:		1 2 3 4 5 6 7 8 9 10		Eggs:
Open minded:		1 2 3 4 5 6 7 8 9 10		Pasta:
Reserved:		1 2 3 4 5 6 7 8 9 10		Rice:
Inrovert:		1 2 3 4 5 6 7 8 9 10		Cheese:
Like routine:		1 2 3 4 5 6 7 8 9 10		Vegetables:
Houmorous:		1 2 3 4 5 6 7 8 9 10		Salads:
Witty:		1 2 3 4 5 6 7 8 9 10		Fruit:
Shy:		1 2 3 4 5 6 7 8 9 10		Sweets:
Body/Beauty Therapies - Do you like:				Cakes:
Remedial massages:				Food allergies:
Relaxing massages:				I like to drink:
Aroma therapy:				Water:
Prev. experience:				Milk:
Do you enjoy:				Hot chocolate:
Exfoliation:				Tea:
Face masks:				Juices:
Mud baths:				Softdrinks:
Pedicure:				Beer:
Manicure:				Wine:
Other:				Spirits:
Sleep Systems:				Others:
Hours of sleep needed:
I sleep on a
Spring matress
Latex matress
Water bed
Futon
Other:

Other comments/wishes: