Age group * Choose an answer… Under 16 16–20 21–29 30–39 40–49 50–59 60+
Gender (optional) Choose an answer… Woman Man Non-binary Other I'd rather not say
Country Choose an answer… Netherlands Belgium Germany United Kingdom United States Other
Highest level of education Choose an answer… Primary school Secondary school MBO HBO University I'd rather not say
Work or study Choose an answer… Employed (full-time) Employed (part-time) Studying Job-seeking Unable to work / on sick leave Retired Other
Living situation Choose an answer… Alone With a partner With family With parents Shared housing Supported housing Other
Relationship Choose an answer… No relationship In a relationship Living together / married I'd rather not say
Children Choose an answer… No Yes I'd rather not say
Reason for this screening * Choose an answer… I recognize these traits in myself Someone else suggested it I'm struggling at work or in my studies I'm already going through a diagnostic process Curiosity Other
When did you first notice autism-related traits in yourself? Choose an answer… In childhood As a teenager As a young adult Only recently Not yet — I'm still figuring it out
Does autism run in your family? Choose an answer… Not that I know of Yes, a confirmed diagnosis Yes, suspected I don't know
Do you already have a confirmed diagnosis? Choose an answer… No Yes, autism Yes, something else In progress I'd rather not say
