The Procrastinator Determiner


Question 1: Enter your name, address, and phone number:

Name:    
Address:
City:    State: Zip:
Phone:   

Question 2: On average, how much time is spent every day thinking about doing something instead of actually doing it?

0-3 hours 4-7 hours 8+ hours

Question 3: What have you missed as a result of procrastination?

Meals     Bathing        Weddings/Funerals
Holidays Child's birth No one cares


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