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Stuttering Demographics
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What is your birth sex?
Male
Female
N/A
Clear selection
What is your gender identity?
Cisgender (identifies with birth sex)
Transgender, male to female
Transgender, female to male
Transgender, nonbinary
Other
Clear selection
How old are you?
Under 18
18-21
21-25
26-30
31-40
40+
Clear selection
What is your relationship status?
Single
Married
In a relationship
Other
Clear selection
What race do you identify as?
White
Black
Asian
Hispanic
Native American
Two or more races
Other
Clear selection
Where are you from?
North America
Europe
Asia
Africa
South America
Oceania
Clear selection
Is English your first language?
Yes
No
Clear selection
Are you employed?
Yes, in a full time position
Yes, in a part time position
No, I'm a student
No, unemployed
What is your political affiliation?
Leftist
Liberal
Centrist/moderate/unknown
Conservative
Very conservative
Clear selection
What is your sexuality?
Heterosexual
Homosexual
Bisexual/Pansexual
Asexual
Other
Clear selection
How severe do you currently classify your own stutter, on an average day?
Very mild/near fluent
Mild
Moderate
Severe
Functionally mute
N/A or nonstutterer
Clear selection
Do you consider yourself to be disabled due to your stutter?
Yes
No
Clear selection
Do you currently, or did you recently, attend speech therapy?
Yes
No
Clear selection
Do you, or did you recently, attend non-speech therapy or other psychological treatment?
Yes
No
Clear selection
When did you start stuttering?
As long as you can remember/unknown
less than 7 years old
8-12
13-18
18-26
27+
N/A or nonstutterer
Clear selection
What parts of your life are more difficult because you stutter?
Nowhere (it doesn't make it more difficult)
Speaking to new people
Speaking to familiar people
Dating
Speaking to people in passing (e.g. cashier, food service worker, etc.)
Speaking on the phone
Doing presentations
Self esteem
Finding employment
Succeeding in school
Discrimination
Prejudice of other people (e.g. people think that you're not as smart because you stutter)
Avoiding communication overall
Isolation
What do you consider your mental outlook to be?
Very poor/extreme depression
poor/general depression
fair/some sadness, but no hopelessness
good/"normal" mental state, not one way or the other
very good/some hopefulness, rare sadness
excellent/usually hopeful and excited about life
Clear selection
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