To get an accurate date of death answer all the following questions honestly, chose the closest answer you feel describes yourself.
Name:
Date of Birth. Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year: 19 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10
1. Do you smoke?
1. I have never smoked.
2. I used to smoke a bit but no more.
3. I used to smoke a lot but no more.
4. I smoke under 20 a day.
5. I smoke over 20 a day.
6. I smoke over 40 a day.
7. I chain smoke.
8. I smoke a pipe.
9. I smoke cigars.
10. I smoke marijuana.
2. Do you drink alcohol?
1. I do not, and never have.
2. I am a reformed alcoholic.
3. I am a weekend booze binger.
4. I only drink wine with my meals.
5. Sometimes my head tells me I've had enough and I stop.
6. Sometimes my head tells me to stop and I keep on going.
7. I drink to excess and always will. I love the stuff.
8. I drink the 'Blood of Christ' on Sunday.
9. I am an alcoholic.
10. I drink moderately.
3. Do you use a mobile phone?
1. I do not own a moblile phone.
2. I use a hands free mobile phone.
3. I use it mainly for text messaging.
4. I need it constantly. I carry a spare battery.
5. I use it a lot but keep the calls short.
6. I get the latest model as soon as it comes on market.
7. This microwave/brain tumour stuff is just nonsense.
8. It's just for emergencies and rarely switched on.
9. I use it a lot but alternate ears.
4. How is your diet?
1. I eat a lot of junk food.
2. I do not eat red meat.
3. I weigh over 100kg (16 stone).
4. I stay healthy with strict dieting.
5. I am a vegetarian.
6. I am a vegan.
7. I eat almost exclusively in restaurants.
8. I have an eating disorder.
9. McDonald's rules.
10. I have a varied and healthy diet.
5. Sex?
1. I am a virgin.
2. I practice safe sex.
3. I have one partner.
4. Sex is all I live for.
5. I am celibate.
6. Only at weekends.
7. It is my occupation.
8. I am a sexual deviant, anything goes.
9. I have occasional sexual encounters.
10. When I find the right person.
6. Drugs?
1. My health dictates I need a lot of medication.
2. It's years since I've seen my Doctor.
3. I take vitamins and minerals.
4. Prescription drugs when necessary.
5. I take illicit soft drugs.
6. I take illicit hard drugs.
7. I prefer alternative medicines.
8. I use both complimentary and health service medication.
9. I take pain killers every morning to keep illness at bay.
10. Pain reminds me I'm alive.
7. How much stress is in your life?
1. I function best under pressure.
2. My boss is a tyrant.
3. My life is full of stress, isn't everybody's?.
4. I am a survivor.
5. When I come home to my family it all makes sense.
6. One day I will move to the country.
7. I lock all doors and close all blinds never answering the door.
8. I get by.
9. When 4 day weekends come along I'll be a happy bunny.
10. It's part of my job. I can cope.
8. and finally, sum up your life as you see it in a few words.
