I would very much love to meet the Osbournes and Steven King and George A Remreo
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Pain, both Phsyical and Emotional (X marks the spot!) ((99 questions)) 
Answer each question with a X 
Leave question answer blank if you haven't done what question says. 
:: Physical :: 
1) Gotten into a fist fight: no 
2) Been beaten up in a fist fight.: no 
3) Had a black eye: no 
4) Broken a bone: yes 
5) Broken more than one bone: yes 
6) Sprained a bone: no 
7) Sprained more than one bone: no 
8) Had a arm or leg dislocated.: yes sholder 
9) Have skinned arms: yes 
10) Have skinned legs: yes 
11) Have skinned face: no 
12) Have skinned back: no 
13) Have burnt hands: no 
14) Have burnt arms/legs: yes I burnt my legg in one sopt 
15) Have burnt face: no 
16) Have burnt back: yes burnt my back in the sun in florida 
17) Been in a car wreck: no 
18) Had a nail pulled off: no 
19) Have had T.B.: no 
20) Have had Bronchitis: yes 
21) Have had Pink Eye: yes 
22) Have had the Flu: yes 
23) Have had the Measles: no 
24) Have had Chicken Pox: yes 
25) Have had Cow Pox: no 
26) Have had Cancer: no 
27) Have had Cancer tumor removed surgically: no 
28) Have had a surgery: yes 
29) Have given birth to a child: no 
30) Have fallen on or over a table: no 
31) Have fallen off a roof: no 
32) Have slipped and fallen while walking in rain: yes 
33) Have slpped and fallen while roller-blading: yes 
34) Have slipped and fallen while ice-skating: yes 
35) Have slipped and fallen while taking a shower: yes 
36) Have had tooth punched out: no 
37) Have gotten injury while playing sports: no 
38) Have accidently cut self with knife or other sharp object: yes 
39) Have been pushed or fallen out of a window: no 
40) Have fallen off a swing while swinging high: no 
41) Have been saved by lifeguard while swimming: yes when i was very young 
42) Have been shot with BB Gun: no 
43) Have been shot with a real gun: no 
44) Have been attacked by a dog or other animal: no 
45) Have fallen off a horse: no 
46) Have walked into a door or door frame: yes 
47) Have puked blood: no 
48) Have had a body parasite: no 
49) Have been in airplane, train, or ship/boat crash.: no 
50) Have been in so much pain you thought you would die.: yes 
:: Emotional :: 
51) Have had close friend/family member pass away: yes 
52) Have had a close friend take advantage of you: yes 
53) Have had a family member take advantage of you: no 
54) Have had a lover take advantage of you: no 
55) Have witnessed a human being die: no 
56) Have witness an animal die: yes 
57) Have been dumped by a boyfriend/girlfriend: yes boyfriend 
58) Have been teased merclessly: no 
59) Have had heart broken: yes 
60) Have cried self to sleep: yes 
61) Have cried for a full day: yes 
62) Have considered suicide: yes 
63) Have attempted suicide: yes 
64) Have thought about burning or cutting self: yes a long time ago 
65) Have burnt/cut self: yes cut my self a long time agao 
67) Have considered running away: yes 
68) Have run away: no 
69) Have been in shock: yes 
70) Have had anxiety/panic attack: no 
71) Have been verbally abused to the point of hating self: no 
72) Have been worried mad: yes 
73) Have been diagnosed depressed: no 
74) Have been diagnosed bipolar: no 
75) Have shut self out from others: yes a long time agao 
76) Have considered doing something you now regret: nop not for a long time 
77) Have done something you now regret: yes I yled at a friend and I have Regreted ever since 
78) Have been in argument with family member/close friend: yes 
79) Have cried because of family member/close friend: yes 
80) Have been disowned by family: no 
81) Have disowned self from family: no 
82) Have considered a life of drugs: no 
83) Have considered a life or crime: no 
84) Have given up on old dreams: no 
85) Have given up on doing things that should been found fun: no 
86) Have lost all will to live: yes at one time 
87) Look foward to death: no 
88) Look foward to sleep: yes 
89) Been blamed for something you didn't do: yes 
90) Been punished for something you didn't do: yes 
91) Worried about something you couldn't control: yes 
92) Stayed up all night worrying: yes 
93) Stayed up all night crying: yes 
94) Stayed up all night cutting/burning self: no 
95) Stayed up all night writing in diary/journal about problems with life: yes 
96) Stayed up all night worrying about your 10 year future: no 
97) Been extremely disappointed: yes 
98) Have had something you've looked foward to ruined: yes 
99) Have had something you planned ruined: yes 
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