{ in good form }

March 13, 2012 § 1 Comment

Actual questions from one of the forms I had to fill out (Please keep in mind that the appointment is at a Women’s Breast Health office):

3. Height: _____________ Weight: __________________ (Please do not lie we will be weighing you) Yes. It actually says don’t lie. Holy Shit my medical form is threatening me to divulge my actual weight. Also if your weighing me anyway why do I have to fill it out, I swear  they are doing it just to catch me in a lie.

15. Who discovered the lump? Circle ALl that Apply. Friend, Partner, Family Member, Doctor, Nurse, Unknown Relationship (I would hope if they were touching you, you would know your relationship to them) or Trusted Religious Leader or Spiritual Guide (does that give anyone else the creeps)

21. Do you still have your uterus? Y or N If you answered No answer the next question if not skip ahead to question number 23.

22. What caused you to loose your uterus? Circle One

  • Birth Deformity
  • Gender Reassignment surgery
  • Hysterectomy
  • Other (if you mark other please explain in detail) now I’m not an expert but really have the first 3 what other ways can one loose their uterus and I so want to write down the most outrageous thing just to see if they would notice-my three favorites below

I’m pretty sure it was the aliens, I woke up in Mexico in a bath tub full of ice and it was gone and a tragic miniature golfing accident, there more common than you would think

32. Which breast are you having problems with? Circle One. Right. Left. Both or Other (Seriously what other could there be, oh yes my fourth breast is really the problem)

47. Before reading this I’ll have you remember my appointment is at The Center for Women’s Breast Health Gender: M or F

and what questioner would not be complete with an essay question. It’s like the SAT’s all over again and like the SAT’s I’m going to leave it blank.

50. In lines provided below please describe your breast especially the nipple for us. (it just seems like something they would use to lure men in on “To Catch a Predator.” )


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