Friday, August 26, 2016


To help us serve you better, there
Is this short and friendly questionnaire
Please start by listing thirty references
Give height and weight and sexual preferences
List your mother’s date of birth and where

State military record including rank
At discharge - leave the next section blank
Do you now, or have you ever had diseases
Like dropsy, psychosis or night-time wheezes
Did you ever swim naked in a stock tank?

Please list your favorite place to dine
Which do you prefer, cold beer or wine?
How well do you stick to a strict diet?
If you knew you would not get caught, would you try it?
Just a few more questions – you’re doing just fine

Print your name and please sign the last page and then
Bring the forms to the window and turn them in
Have a seat over there and fairly soon
A nurse will usher you back to a room
Where she’ll ask you all of these questions again

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