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What gender are you?
 
Male
 
Female

 
 
 
What age group are you?
 
Under 15
 
16 to 25
 
26 to 35
 
36 to 45
 
45 and above

 
 
 
What religion are you?
 
Christianity
 
Islam
 
Hinduism
 
Buddhism
 
Other
 
 
 
What is your marital status?
 
Married
 
Single
 
Widowed
 
Divorced/Separated
 
 
 
What is your sexuality?
 
Heterosexual
 
Homosexual
 
Bi-sexual
 
 
 
Have you got any of the following?:
Hearing problems
Sight problems
Disability problems
Language barriers or problems
 
Yes
 
No
 
 
 
What continent are you from?
 
Australia
 
America
 
Asia
 
Africa
 
Antarctica
 
Europe
 
South America
 
North America
 
 
 
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