Little Bitch Report Form

Please complete in full using BLOCK CAPITALS.

Name

Date of butthurt

Choose from the following reasons why you are being a little bitch:

I lost an argument
My opinion was wrong
I found something offensive online and couldn't move on
I have no sense of humour
No one will let me suck their dick
Someone was rude back to me
I have nothing better to do

Do you require medical assistance / tissues? Yes No

On a scale of 1 - 10 (1 being mild anal itching and 10 being crippling agony) how much does your butthurt hurt?

1 5 10

Current level: 5/10

Have you ever considered not being a little bitch? Yes No

Use this section to provide any extra information you think relevant (use separate sheet if necessary)

Using the diagram, indicate exactly where the internet bad touched you.

Selected areas:

None