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| Name: |
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| Age: |
<8
8
9
10
11
12
13
14
15
16
17
18
>18
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| What diapers do you wear? |
Cloth
Disposable
Multiple Underpants
I do not wear diapers
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| Are your diapers plain white? |
Always
Usually
Sometimes
Rarely
Never
I do not wear diapers
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| Do you wear multiple diapers? |
Always
Usually
Sometimes
Rarely
Never
I do not wear diapers
|
| Are you pantsless at home while in diapers? |
Always
Usually
Sometimes
Rarely
Never
I do not wear diapers
|
| How do you use your diapers? |
Pee
Poop
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| Who else in your family has read this story? |
Mother
Father
Older Brother
Younger Brother
Older Sister
Younger Sister
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| Your comments: |
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| Parents' comments: |
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| Brothers' comments: |
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| Sisters' comments: |
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