MEDICAL HAVE YOU EVERS:
[ ] i have broken my arm
[ ] i have broken my leg
[] i was on crutches for a medical reason not just for fun
[] i was in a wheelchair for medical purposes, not fun
[x] i have had a concusion
[x] i have needed stitches
[x] i have had memory loss
[x] i have broken someone elses bone on purpose
[x] i have broken someone elses bone on accident
[x] some has broken my bone purposly/on accident
HOW MANY:6

DECISION MAKING HAVE YOU EVERS:
[x] i have smoked a ciggarette before
[x] i have smoked pot before
[ ] i have done cocaine before
[ ] i have done heroine before
[] i have done any other drugs
[x] i have dranken alcohol before
[x] i have snuck out of my house before
HOW MANY: 4

LOVE/RELATIONSHIP HAVE YOU EVERS:
[x] i have been in love
[x] i thought i was in love
[x] i've kissed someone of my gender
[x] i've kissed someone of the opposite gender
[x] i've made out with someone of the same gender
[x] i've made out with someone of the opposite gender
[x] i've had a boyfriend/girlfriend before
[ ] i've never had a bf/gf before
HOW MANY:7

INSANE HAVE YOU EVERS:
[ ] i have been streaking
[x] i have been skinnydipping
[x] i have flash/mooned someone
[ ] i have hitch hiked
[x] i have eaten a worm
[x] i have peed my pants after age of 6
[ ] i have pooped my pants after age 6
[x] i have eaten glue/paste/glitter/paper
[x] i have eaten grass
[x] i have tried dog or cat food
[x] i've went to the bathroom outdoors
[x] i've rolled over the hood of a moving vehicle
[x] i've layed in the road waiting to get hit
HOW MANY: 10

FIGHTING HAVE YOU EVERS
[x] i have been in a a physical fight with a family member
[x] i have been in a physical fight with an enemy
[ ] i have been beaten up before (by anyone)
[x] i have beaten someone up before (anyone)
[x] i'd had a verbal fight with someone
[ ] i've bled during a fight
[x] i've made someone bleed during a fight
[x] i've had my hair pulled
[x] i've had a black eye
[x] i'd had a busted lip
[x] i'd had a bloody nose