Done
I don't know if you are accepting feedback but...by not allowing people to select an age younger that 16 for when they started to s/h you are giving yourself inaccurate data. I would have chosen younger if it was possible, I'm sure from other people's stories here that others also started younger.
Also, some of your preset answers are really limiting and force people to choose an answer that doesn't fit, just fits better than the others. That might give you great data for your write up...but won't tell you anything in real terms.