Name:
Date of birth:
How many cigarettes do you smoke: (never smoked/ sometimes/ never stop)
How many units of alcohol do you drink a week:
Have you ever had unprotected sex (yes/no)
Has your family got any bad diseases: (if so please specify)
Sex:
Now please fill this in and send it to me and i will send you back the day you will die. Now please dont take the awnser seriously it is just a bit of fun.
add us both xD
