There are 20 questions in total. 1. Are you able to follow directions? Yes No None 2. Have you ever zoned out during a meeting or lecture? Yes No None 3. Can you imagine yourself as one of the characters in a movie? Yes No None 4. Can you imagine the sound of a train whistle blowing? Yes No None 5. Have you ever driven in a car and the time seemed to fly by? Yes No None 6. Can you wake up from sleeping get a drink and go right back to sleep? Yes No None 7. If you walked past a crowd and everyone was looking up would you look up? Yes No None 8. Have you ever ‘rested your eyes’ while watching TV and didn’t go to bed? Yes No None 9. Are you able to meditate? Yes No None 10. Have you ever been so caught up in a good book and couldn’t put it down? Yes No None 11. While listening to an old song can you remember who where you were when you heard it? Yes No None 12. Have you ever cried or been frightened watching a movie? Yes No None 13. Did you ever lose time while doing something enjoyable? Yes No None 14. Did you ever begin to yawn after seeing someone else yawning? Yes No None 15. Do you shudder when thinking about scraping nails on a blackboard? Yes No None 16. Does your mouth water when you think of biting into a juicy lemon? Yes No None 17. Have you ever bought a bag of popcorn impulsively after smelling it? Yes No None 18. When someone says they feel warm, do you begin to feel warm also? Yes No None 19. Do you tune someone out if they are speaking in a monotone? Yes No None 20. If someone talks about a fear that you too have experienced, do you get a nervous feeling also? Yes No None Time’s up
