Fill out our Drug Addiction questionairre!

Male:
Female:
Shim:

under 18:
18-29:
old:

Do you smoke cigarettes?

yes:
no:
only when I'm drinking:

Do you drink alcohaul?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you smoke weed?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you do cocaine?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you take E?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you take oxycotton?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you take shrooms?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you shoot heroine?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

Do you take valium or perkisets?

yes, frequently:
yes, occaisionally:
yes, seldomly:
no:

If you answered "yes, frequently", or "yes, occaisionally" to two or more questions then you should die within the next ten to twenty years.