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* 1. Were you a member of the Jehovah's Witness organization?

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* 2. What is your current status in regards to the Jehovah's Witnesses

  Still attend meetings No long attend meetings
Baptized Active
Baptized Inactive
Dissfellowshiped
Disassociation

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* 3. When you left did you experience any of the following:

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* 4. Length of the above symptoms

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* 5. Did you self medicate with drugs and/or alcohol

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* 6. Were your sleeping patterns altered after leaving the Jehovah's Witnesses?

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* 7. Did you begin using tobacco after leaving the Jehovah's Witnesses?

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* 8. Do you missed people in the Jehovah's Witnesses organization?

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* 9. Frequency of your urges to return to the Jehovah's Witnesses. (Please be completely honest, please count even slight desires)

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* 10. If you could return to the Jehovah's Witnesses without any questions from anyone would you reinsert yourself into your old Jehovah's Witness self?

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