First Questions
These questions are the basics of what we would like to know.
What day did the bad date happen?
Month (MM)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
Day (DD)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year (YYYY)
What time did the bad date happen? Include AM/PM.
Location of Meetup
Location of Incident
How did this bad date contact you?
in person
they called or texted me
they emailed me
I don't remember
Other:
Comments:
How did this bad date find you?
in person/ on the street
print ad
online
I don't remember
Other:
Comments:
Can you provide the bad date's phone number?
Can you provide the bad date's email address?
Can you provide the bad date's name?