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Name*
First Last
ATTENTION: Fix Me Up! is a real dating service. You are NOT joining a dating website and there will be no logging in here, looking at pictures, etc. ALL members must meet with us face-to-face (video chat option is available). While we may be affordable, we are not a free service. This application will allow us to arrange your consultation. Please make sure you have read the information in the FAQ section before filling out this form. Thanks!
Age*
We take on female clients ages 18+ and male clients ages 21+.
Gender*
Email*
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You'll receive an automated response once you have submitted the form.
Cell Phone*
We don't take home phone numbers. Please double check your phone number before submitting. The next step for us will be to call this phone number, so you may want to save our number.
Where in Northeast Ohio do you live?*
You MUST be located in Northeast Ohio to be a member. Please don't fill this out if you are not a US resident living in Northeast Ohio. Someday we'll be in your area!
Do you use tobacco products?*
How did you hear about us?*
Please select the one that you either saw first or the one that you see most frequently; this helps us learn which advertising strategies are most effective.
Email
This field is for validation purposes and should be left unchanged.