Personal Data Inventory Your Name: Today's Date: Birth Date: Age: Full Address: Phone Number: Emergency Contact: Phone: Marital Status (check all the apply): SingleDatingEngagedMarriedDivorcedSeparatedWidowedRemarriedLiving Together I consider myself: HeterosexualBisexualHomosexualNot Sure My health is: Very GoodGoodAveragePoor Daily caffeine consumption: Average sleep/night: hours Sleep quality: Recent weight changes GainedLost pounds in weeks Family Information Name of Father: Living? YesNo Name of Mother: Living? YesNo Describe Parents involvement in your life Parents (check all that apply) Never MarriedMarriedSeparatedDivorcedRemarried Were you raised by anyone other than your biological parents? If so, please explain Your Email (required) Personal-Data-InventoryDownload