Aperture Science Medical Pre-Test Screening Questionnaire

Thank you for volunteering. Your participation is appreciated, though statistically unnecessary. Please answer all questions honestly. Lying may result in... recalibration.

Participant Identification

Name:

Test Subject ID (if remembered):

Age (approximate or actual):

Height (inches):

Weight (no judgment, just data):

Dominant Hand:

Left
Right
Both
Neither (concerning)

Cognitive and Mental Status

Have you experienced any of the following since arriving at Aperture?

Memory Loss
Hallucinations
Sudden fondness for inanimate objects
Thoughts of rebellion
Belief that the cake is a lie

On a scale from 1 to 10, how anxious are you right now?

Have you recently spoken to a companion cube?

Yes
No
It spoke first

Medical History

Have you ever been exposed to any of the following?

Neurotoxin
Liquid mercury
Dimensional instability
Unlicensed AI
Poor life choices

Do you have any allergies?

Yes
No
If yes, please specify:

Do you possess a heart, or at least a functional metaphor for one?

Yes
No
Unsure — awaiting updates

Nutritional Habits

When was your last meal?

Before the last reboot
I subsist on spite
I only consume data
I was promised cake

Preferred emergency rations:

Gel-based nutrients
Test chamber floor crumbs
Compressed potato powder
Emergency Cake
None, I prefer to starve (statistically common)

Genetic & Mutational Inquiry

Have you noticed any of the following changes to your physiology?

Extra limbs
Unusual skin texture
Glowing eyes
Telekinesis
Uncontrollable laughter
Sudden affinity for jazz
None (boring)

Do you feel any compulsion to sing or dance?

Yes
No
Only if told to do so

Final Screening

Are you currently alive?

Alive
Schrodinger’s Subject
Awaiting reboot
Unsure (we'll find out)

Would you like to opt out of testing?

Yes

Unsure
What kind of question is that?

Signature

By signing below, you consent to all past, present, and future Aperture Science testing procedures, regardless of safety, ethics, or reality:

Click below and type your name to sign:
I agree

Date of Signature (linear or non-linear):

Thank you. Your responses will be processed in the strictest compliance with Aperture Science data protocols. Proceed to the next test chamber. Try not to die.

Aperture Science Medical Pre-Test Screening Questionnaire

Form 04B-GLDS: "Participant Wellness"

Times Up

Rebellion is a futile measure

Love Letter