1.  What is your gender?

2.  What's your age range?

3.  Have you ever had a sexual fantasy or urge that involved urophilia (arousal from urine and/or urination)?

4.  Have you ever engaged in sexual behaviors and activities that involved urophilia?

5.  Have you ever had a sexual fantasy or urge that involved coprophilia (arousal from feces and/or defecation)?

6.  Have you ever engaged in sexual behaviors and activities that involved coprophilia?

7.  Have you ever had a sexual fantasy or urge that involved emetophilia (arousal from vomitand/or vomiting)?

8.  Have you ever engaged in sexual behaviors and activities that involved emetophilia?

9.  Do you feel your sexual attraction and arousal to urine, feces, and/or vomit is healthy and/or beneficial for you?

10.  Do you feel your attraction and arousal to urine, feces, and/or vomit developed from or connects to your past childhood experiences?