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I have the following condition(s): (Check all that apply)	ADD/ADDHD Allergies Amputee Anxiety Disorders Arthritis Autism/Aspergers Blindness/Eye Health Burn Survivors Cancer Cerebral Palsy Chronic Fatigue Syndrome (CFS) COPD/Asthma/Breathing Disorders Deaf and Hard of Hearing Diabetes Disabled Dyslexia/Speach and Language Disorders Epilepsy Heart Disease/Stroke/Angioplasty Hepatitis Herpes HIV (Aids) HPV Infertility & Impotence Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) Little People Lupus Multiple Sclerosis Other Overweight Paraplegic Parkinson's Disease Psoriasis/Dermatitis/Skin Problems Psychiatric Disorders/Bipolar Quadriplegic Recovering Alcoholics Tourette Syndrome Transplant Patients Other(s):
I am interested in dating others with the following condition(s): (Check all that apply)	ADD/ADDHD Allergies Amputee Anxiety Disorders Arthritis Autism/Aspergers Blindness/Eye Health Burn Survivors Cancer Cerebral Palsy Chronic Fatigue Syndrome (CFS) COPD/Asthma/Breathing Disorders Deaf and Hard of Hearing Diabetes Disabled Dyslexia/Speach and Language Disorders Epilepsy Heart Disease/Stroke/Angioplasty Hepatitis Herpes HIV (Aids) HPV Infertility & Impotence Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) Little People Lupus Multiple Sclerosis Other Overweight Paraplegic Parkinson's Disease Psoriasis/Dermatitis/Skin Problems Psychiatric Disorders/Bipolar Quadriplegic Recovering Alcoholics Tourette Syndrome Transplant Patients Other(s):
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Religion:	Agnostic Atheist Buddhist Christian Hindu Islam Judaism Pagan Taoism Spiritual, but not religious Not Religious
Children:	No Yes - Live at Home No - Live Away
Want Children:	Yes No Perhaps
Smoking:	Daily Socially Trying to Quit Not at All
Drinking:	Daily Socially Trying to Quit Not at All
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