Age Survey

Age Survey

Please fill in form as accurately as possible if you cannot provide an answer to a question please leave blank but please do try to answer all questions unless a question does not apply to you, which will be assumed if left blank. All answers submitted are confidential and encrypted.
Name:

First name Last name
Referred By/Found us on:
Name of friend or social media platform
Email:
wink@me.com
Phone Number

Area CodePhone Number
Birthday*

YearMonthDay
Date
Time of birth

Hour Minutes

AM/PM Option
Sex

MaleFemaleRather not say
How old do you feel in your mind? *
Age
How old would you be if you didn't know how old you are?
Age
What age is your earliest memory?
Age
In your opinion, what is the best age to be?
Age
What can you tell me about your 22nd year?
What age do you hope to reach?
How old when you had your first kiss?
How old were you when you had your first relationship?
How old were you when you had your first break up?
How old were you when you got married?
How old were you when you had your first child?
If you could pick an age to return to what age would that be?
Age
How old were you when you brought your first mattress?
How old were you when 9/11 happened?
How old were you when you found out Santa isn't real?
How old were you when you got your first tattoo?
When are you old? What age to you is considered old?
Age you were when you experienced death of a loved one for the first time?
What was your favourite age?
Age
What was your least favourite age?
Age
Have you ever feared a birthday?
Age
What birthday were you most exited about?
Age
How old were you when you were taught about love?
Age
How old were you when you became aware of love yourself?
Age
How old were you when you first experience self-love?
Age
How old were you when you were given "the talk"?
Age
What age did you learn about sex for the first time?
Age
How old were you when you lost your virginity?
How old were you when you fell in love with someone else for the first time?
Age
First time saying "I love you"?
Age
What age do you think you may die?
Age
How old were you when you were first traumatised?
Age
First experience with any form of mental health issues?
Age
If you've ever experimented with drugs, how old were you when you had your first experience?
Age
Create a new word:
Your new word
Give your word meaning:
Definition
How awesome are you?
Should be Empty: