Survey on psychiatric covariation, second revision

Fill in below as well as you can

Psychiatric diagnosis or self-diagnosis

Select most appropriate: Relative with diagnosis ADHD/ADD Asperger/PDD Low-functioning autism Other

Age

Age not given 0 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 +

Gender

Select gender Male Female

Animals

Number of dogs No dog 1 dog 2 dogs 3 or 4 dogs 5 or more dogs

Number of cats No cat 1 cat 2 cats 3 or 4 cats 5 or more cats

Number of other animals No other animals 1 other animal 2 other animals 3 or 4 other animals 5 or more other animals

What do you think about animals? Allergic against animals Don't like animals Likes animals a little Likes animals moderately Likes animals a lot Likes animals very much

Favorite temperature

Temperature not given 0 - 4 Celsius / 32 - 40 Fahrenheit 5 - 9 Celsius / 41 - 49 Fahrenheit 10 - 14 Celsius / 50 - 58 Fahrenheit 15 - 20 Celsius / 59 - 67 Fahrenheit 20 - 25 Celsius / 68 - 76 Fahrenheit 25 - 30 Celsius / 77 - 85 Fahrenheit över 30 Celsius / above 86 Fahrenheit

Big and second toe relation

Not given Big toe longer Equal length Second toe longer

Forefingers relation to ring-finger

Not given Forefinger longer Equal length Ring-finger longer

Dandruff

Not given No A little Intermediate A lot Very much

Knock kneed

Not given No A little Intermediate A lot Very much

Stooping

Not given No A little Intermediate A lot Very much

Vision

Not given Normal sight A little short-sighted A little short-sighted + astigmatism Very short-sighted Very short-sighted + astigmatism A little long-sighted A little long-sighted + astigmatism Very long-sighted Very long-sighted + astigmatism

Squinting

Not given No A little Intermediate A lot Very much

Cold feet

Not given No A little Intermediate A lot Very much

Depression

Not given Seldom or never Mostly in the winter Both summer and winter Mostly in the summer

Diabetes

Not given No Since childhood As an adult Low blood-sugar

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