How old are you?

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City

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Zip

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Do you live at home with your mother?
yesno
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If so, for how many years?

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What are your reasons for living at home?
please choosefinancialmother needs youit’s comfortableAll of the above
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How often do you speak to your mother?
please chooseOnce a week or less2-5 times a week6 or more
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How often do you include your mother into your social activities?
please chooseOccasionallySometimesAll the time - Hey, She's my Mom!
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Do you consult your mother on every major decision in your life?
yesno
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Does your mother have to approve of your girlfriend/wife/partner?
yesno
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If you were to get a tattoo: would it be professing your love for your mother or your girlfriend/wife/partner?
please choosemothergirlfriend/wife/partner
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Do you ever have fights with your girlfriend/partner or wife about your closeness to your mother?
yesno
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Would you describe yourself as:
Confident
Shy
Ambitious
Lazy

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Is your mother:
please chooseSingle?Happily married?Married but not happy?
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How would you describe your mother?
please chooseSaintlyPerfectBoth 1 and 2NeedyControllingBoth 4 and 5
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Does your mother influence every decision that you make?
yesno
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Do you consider yourself a “mama’s boy?’
yesno
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If so, do you think that’s a positive association?
yesno
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