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CROSS-DOMINANCE
ALERT - PLEASE COMPLETE ONLY IF YOU IDENTIFY AS BEING CROSS-DOMINANT
- this form assumes you have certain body parts; if you do not have these body parts, please leave the question/s blank -
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* Indicates required question
What was your sex at birth?
*
MALE
FEMALE
INTERSEX
What year were you born?
*
Your answer
What country/countries did you grow up in from the ages of 0 - 18 (please include time frames as well)?
*
Your answer
What is your ethnicity?
*
Your answer
What country/countries are your primary caregivers from?
*
Your answer
What is your MBTI personality type? (If you do not know, please follow this link -
https://www.16personalities.com/free-personality-test
- and complete the test; it takes around 10 minutes to complete)
*
Your answer
Which two dimensions out of the five do you score highest on in the Big Five personality test (please add percentages as well)? (If you do not know, please follow this link -
https://www.truity.com/test/big-five-personality-test
- and complete the test; it takes around 5 minutes to complete)
*
Your answer
Which do you consider yourself to be predominantly?
*
INTROVERT
EXTROVERT
AMBIVERT
Who are you sexually attracted to?
*
MEN
WOMEN
BOTH
NONE
What age did you realise you are cross-dominant?
*
Your answer
If you have a dominant hand, which one is it?
*
LEFT
RIGHT
NEITHER
Did any physical injury occur to any hand to cause/allow you to start using your less dominant hand (if you have one)? If so, at what age did this occur and is the injury still affecting you?
Your answer
Do you have any physical health issues? If so, what are they?
*
Your answer
Do you have any mental health diagnoses and conditions? If so, what are they?
*
Your answer
Do you have any learning difficulties? If so, what are they?
*
Your answer
To your knowledge, do any of your family members have any mental health diagnoses and/or conditions? If so, what are they?
*
Your answer
What are your parents'/primary caregivers' religious beliefs?
*
Your answer
What are your religious beliefs?
*
Your answer
During your early years of home life, were you pressured to pick a hand to write with?
*
YES
NO
During your early years of education, were you pressured to pick a hand to write with?
*
YES
NO
Which is your preferred way of learning?
*
VISUAL
AUDITORY
READING & WRITING
KINESTHETIC
MULTIPLE OF THE ABOVE
Did you have trouble reading and/or writing when you were growing up? If so, is the trouble still present?
*
Your answer
Do you have any form/s of synaesthesia? If so, please describe them.
*
Your answer
Have you ever experienced psychosis?
*
YES
NO
If you have ever undertaken recreational drugs, what drugs have you taken and roughly how many interactions have you had with these drugs (please include time frames as well)?
*
Your answer
Which hand do you predominantly write with?
LEFT
RIGHT
BOTH
Clear selection
Which hand do you predominantly draw with?
LEFT
RIGHT
BOTH
Clear selection
Which hand do you predominantly hold a knife and chop food with?
LEFT
RIGHT
BOTH
Clear selection
Which hand do you predominantly brush your teeth with?
LEFT
RIGHT
BOTH
Clear selection
Which hand do you predominantly throw with?
LEFT
RIGHT
BOTH
Clear selection
Which foot do you predominantly kick with?
LEFT
RIGHT
BOTH
Clear selection
If you were to cross your leg when sitting down on a chair, which leg would be crossed?
LEFT
RIGHT
EITHER
Clear selection
If on a bus with many empty seats to choose from, which side of the bus would you prefer to sit on?
LEFT
RIGHT
EITHER
Clear selection
When walking with another, which side do you prefer to walk beside them?
LEFT
RIGHT
EITHER
Clear selection
Do you get confused with left and right directions?
*
YES
NO
Do you have difficulties with understanding directions (maps/gps)?
*
YES
NO
Do you find it easier to understand information/directions when you are facing the same direction as the individual speaking to you?
*
YES
NO
Before you start a new activity/task, do you try with both hands/feet first to see which is easier and/or more comfortable?
YES
NO
Clear selection
Do you excel in creative activities/tasks?
*
YES
NO
Are you good at learning different languages?
*
YES
NO
Are you good at playing instruments? If so, which instruments?
*
Your answer
Are you good at playing sports? If so, which sports?
*
Your answer
Are you spatially aware?
*
YES
NO
Are you very clumsy?
*
YES
NO
Does your mood change quickly?
*
YES
NO
Do you get agitated easily?
*
YES
NO
Are you impatient?
*
YES
NO
Do you get distracted easily?
*
YES
NO
Do you have difficulties multitasking?
*
YES
NO
Do you have trouble making small-scale decisions? (I.e. picking what food to order at a restaurant)
*
YES
NO
Do you have trouble making large-scale decisions? (I.e. deciding whether or not to quit your current job)
*
YES
NO
Do you have a tendency to overthink?
*
YES
NO
Are you very logical?
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YES
NO
Are you very open-minded?
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YES
NO
IT DEPENDS
Do you try to understand many different angles of a point of view?
*
YES
NO
Are you highly curious?
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YES
NO
Are you highly intuitive?
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YES
NO
Do you have a vivid imagination?
YES
NO
Clear selection
Are you often striving for balance in your life? Please state what the word 'balance' means for you and how you are doing so (if you are)
*
Your answer
Please tell me some strengths and deficits you have noticed from being cross-dominant (if you have noticed any)
*
Your answer
Please write your name below (if I know you)
Your answer
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