Question Title

* 1. Gender (assigned or chosen)

Question Title

* 2. Age Range

Question Title

* 3. Home Life Prior to Age 16

Question Title

* 4. Emotional Stability of Your Home Enviornment Prior to Age 16

  Least Stable 2 3 4 Most Stable
Stability

Question Title

* 5. Role in Your Dynamic

Question Title

* 6. Any Additional Information You Feel May be Relevant You Would Like to Share

T