Welcome! Please use this form to join our network, whether you’re interested in becoming a matchmaking client or joining our database as a free member.

Service Area: At this time, we are only accepting members and clients residing within the United States. If you are based internationally, we encourage you to seek out matchmaking or dating coach options in your local area.

Membership Information

First Name *

Last Name *

Email *

Phone *

Location

Membership Type *

We work one-on-one with our clients and you are indicating that you would like to be contacted to learn more about our services. Joining the free database is putting your details on file in the event that we have a matchmaking client that we think would be a match for you. There are no guaranteed introductions by joining the free database and you will only be contacted if you are a match.

How did you hear about Mosaic Matchmaking? *

If friend, family or other, please tell us who referred you?

Basic Information

I am a *

Birthdate *

Relationship Status *

Ethnicity *

Height *

Faith / Religion *

Education Level *

Occupation / Job Title *

Income *

Do you have children? *

How many children do you have?

Do you want children/more children? *

What is your political affiliation?

Do you smoke?

Do you drink?

Do you have pets? If so, what kind of pets do you own?

About Me

Brief Bio *

Please describe yourself and what you would bring to a relationship. You can write as much or as little as you want.

What activities and hobbies do you enjoy? What do you do on the weekends and in your spare time?

Are you introverted or extroverted (Introvert is a 0 and Extrovert is a 10)?

Match Preferences

I am looking for a *

Describe what you are looking for in a partner.

Please list any deal breakers when considering a partner.

Photos and Social Media

Please include your social media handle or link to social media page.

Instagram, Facebook, Twitter

Please include a link to your LinkedIn or additional social media page.

Head Shot Photo *

Please upload a solo photo taken within the last three months.

Full Body Photo *

Please upload a solo photo taken within the last three months.

Additional Photo

By submitting this form, I agree to Mosaic Matchmaking's Terms and Conditions and Privacy Policy and confirm that I live in the United States.

I accept the Terms and Conditions