Get Started!

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. 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 on the website before filling out this form. Thanks!
Age*
We take on female clients ages 18+ and male clients ages 21+.
Gender*
Email*
Enter Email Confirm Email

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.
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.
Comments
This field is for validation purposes and should be left unchanged.