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Dating with a Disability
*
1.
What is your age?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
*
2.
What is your gender?
(Required.)
Prefer not to answer
Male
Female
Non-Binary (explain)
*
3.
What is your disability?
(Required.)
*
4.
How old were you at the onset of your disability?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Born with disability
*
5.
Did you date before you were disabled?
(Required.)
Yes
No
*
6.
How many dates have you been on in the last year?
(Required.)
*
7.
How do you find dates?
(Required.)
8.
Briefly describe a recent date that was particularly good or bad.
*
9.
We’re interested in honest stories about the highs and lows of dating with a disability. Would you be willing to be candidly interviewed for a story on dating and to have your story published?
(Required.)
Yes
No
Current Progress,
0 of 10 answered
