1. Instructions and time to complete


Greetings, this survey is for biologically born WOMEN ONLY and is part of a larger research study. Do not take this survey unless you are a woman. AGAIN, DO NOT TAKE THIS STUDY UNLESS YOU WERE BORN AND REMAIN A BIOLOGICAL WOMAN.

This survey is to help our understanding of women's needs and women's evolution with respect to identity, confidence and in relationships...if you stop halfway through, your incomplete survey compromises the research. So, it is VITAL that you finish the survey. It takes the average person 45 minutes to complete, but in the next week, we will have cut the survey to 25 minutes.

We are, as we speak (Feb 2013) shortened the survey. If you choose to proceed now, please make the commitment. Do not think too much about the answers, answer the first answer that comes to your mind.

Please do not start until you have time to take and complete the WHOLE SURVEY in ONE sitting!!!!

This survey is completely utterly totally anonymous, so answer honestly about your behavior and attitudes so we can learn about women's needs, feelings, and behaviors.

Please encourage as many other women to complete the survey as we are learning important things about women and it will affect our understanding of women. You are an important contributor to this research and your experiences count! The confidential results will be presented at a womens conference this year.

And last, if after completing this survey, you wish to participate in a 4-week free womens group and/OR you and a group with your child/teen, please contact the author, Dr Lisa.


Blessings and thank you.

* 1. Which of the following best describes you?

* 2. The gender I relate to is:

* 3. Age:

* 4. Race: (pick answer that best describes your race)

* 5. What part of the world were you born in:

* 6. Estimate the annual income of your family of origin:

* 7. Estimate your own personal income now:

* 8. Level of Education:

* 9. What is your profession:

* 10. Political Affiliation: (pick the answer that best describes you currently)

* 11. Relationship status:

* 12. I am satisfied with my current relationship status.

* 13. Number of sexual partner(s) in your life:

  0-5 6-10 11-20 21-50 51-100 101-200 201-500 501+
Minimal to no genital touch:
Genital touch but no intercourse:

* 14. Disabilities:

* 15. Psychiatric Diagnosis:

* 16. Chronic physical Diagnosis:

* 17. Are you currently on medication?

* 18. If yes, which ones:

* 19. Alcohol and drug use (check all that apply)

  Not Applicable Addiction/Past Addiction/Present Recreational/Past Recreational/Present
Prescription drugs

* 20. Have you ever been a victim of domestic violence in your family of origin?

* 21. Were other members of your family victims of domestic violence?

* 22. Have you been a victim of domestic violence as an adult with a current or past partner?

* 23. Spiritual or Religious Affiliation:

* 24. Which holistic activities are you now or in the past involved in?