PARTICIPANT INFORMATION

Name: (First name only or pseudo name)

Age:
Location:
Time Started:
Time Ended:

Brief Background on your Synesthesia (First realization, etc.):

Formally Diagnosed? Yes  No 

Genetic? 
 TEST
UPPER CASE LETTERS

O
M
S
Z
K
B
X
C
I
U
LOWER CASE LETTERS

o
m
s
z
k
b
x
c
i
u
Questions/Comments/Concerns:

Thank you!
Please return the test to caustinv@gmail.com.