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Are you male or female?
 
male
 
female
 
 
 
Do you have misophonia?
 
yes
 
no
 
 
 
Do your family and close friends know you have misophonia?
 
yes
 
no
 
 
 
If yes, are they:
 
supportive
 
unsupportive
 
indifferent'
 
adversarial
 
 
 
How about co-workers and teachers? Do they know you have misophonia?
 
yes
 
no
 
 
 
Again - if so, are they:
 
supportive
 
unsupportive
 
indifferent
 
adversarial
 
 
 
Are you currently involved in a specific treatment option?
 
yes
 
no
 
 
 
What treatment(s) are you undergoing or employing?
   
 
 
 
How effective are these treatments?
 
not helpful
 
somewhat helpful
 
I'm pleased with this treatment
 
extremely satisfied
 
 
 
What are some of your usual coping mechanisms?
   
 
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