Synaesthesia Survey
First Name:
Last Name:
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Birthday: (MM/DD/YYYY)
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 1. At what age did you first realize you perceived the world in a different way than others around you?
 
      Age:
 
      Please describe the situation.
     
 
2. At what age did you first learn that these experiences reflected synaesthesia?
 
      Age:
 
3. Please indicate which of the following characterize your synaesthetic experiences        (Please check all that apply):
 
              Digits evoke colors
              Letters evoke colors
              Digits evoke personalities
              Letters evoke personalities
              Words evoke colors
              Names evoke colors
              Units of time trigger colors
              Spoken sounds evoke colors
              Musical sounds evoke colors
              Pain evokes colors
              Odors trigger colors
              Personalities trigger colors
              Tastes evoke colors
              Sound evoke tastes
              Sound evokes touch
              Vision evokes taste
              Touch evokes taste
              Sound evokes odor
              Temperature evokes colors
              Taste evokes touch
              Touch evokes smell
              Vision evokes touch
              Other
4. Some synaesthetes report that their synaesthetic experiences occur "out there in space" while others report that their synaesthetic experiences occur "in their mind's eye". 
 
     Which statement best categorizes your synaesthetic experiences:
              Out there in space
              In my mind's eye
              Neither
 
     If "neither", please describe. 
     
5. Was there a time that you remember not experiencing synaesthesia'?
 
               Yes No
 
        If "yes", please describe.
      
6. Have your synaesthetic experiences changed over time?
 
               Yes No
 
        If "yes", please describe.
      
7. Can you intentionally stop the synaesthetic experiences from occurring?
 
               Yes No
 
        If "yes", please describe.
      
8. As far as you know, do any of your relatives experience synaesthesia?
 
               Yes No
 
        If yes, please indicate how these people are related to you and what kind of
        synaesthesia they may have.
      
9. Would you be interested in participating in studies designed to find out more about synaesthesia?
 
               Yes No