Favorites, History, & Preferences


  • My favorite color is:
  • My favorite flower is:
  • My favorite candy is:
  • My favorite chocolate bar is:
  • My favorite movie is:
  • My favorite song is:
  • My favorite pet is:
  • My favorite alcoholic drink is:
  • How often do I drink alcoholic beverages?
  • My favorite drink is:
  • My favorite conversation topics are:
  • My favorite book is:
  • My favorite childhood cartoon was:
  • My favorite childhood toy was:
  • My preferred room temperature is:
  • The toilet paper should come from the (top/bottom):
  • I am (neat/messy):
  • Three things I like most about me are:
  • Three things I like least about me are:
  • My greatest personal strength is:
  • My greatest personal weakness is:
  • The parts of my body I like most are:
  • The parts of my body I like least are:
  • Someone that I really admire is:
  • What I fear most is:
  • What I need most is:
  • My most frequent mood is:
  • I find my greatest joy in life when:
  • I dislike people who:
  • What hurts me the most is:
  • An accomplishment I feel most proud of is:
  • Something I feel the most regret about in my life is:

My History & Preferences

Personal Issues

  • Do I have a criminal record? What’s on it?
  • Do I have any skeletons in my closet? (i.e. past trauma, previous relationships, etc.)
  • Have I ever hit someone? Why?


  • List childhood diseases, injuries or operations:
  • List past adult diseases, injuries or operations:
  • I had my last complete physical examination on ______________________.
  • List present diseases or injuries (include high blood pressure, arthritis, migraine headaches, etc.)

Diet & Exercise

  • How many pounds have you gained and/or lost in the past year?
  • Describe any of your past and present diet programs:
  • Describe your exercise program:
  • What drugs do you presently take, what dosages, how often and why?
  • Have you been hospitalized or received therapy for a mental disorder?


  • What were your childhood interests and hobbies?
  • What are your present leisure time interests and hobbies?
  • Are there hobbies/activities we should do together that we aren’t currently doing?


  • I have traveled to…
  • I’d like to travel to…

Alone Time

  • What is my ideal amount of alone time?
  • I should communicate that to my partner by…
  • How much TV should I watch?

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