How Do You Really Feel About Your Body

* What is your first name?

* How old are you?

* What is your current weight?

* How tall are you (in feet and inches)?

Are you satisfied with your current weight?

Yes

No

How do you feel about your current physcial image?

Attractive

Unattractive

Would you prefer to change your current weight?

Yes

No

How much would you like to change your weight by?

Is it good to have extra weight, as long as it is where you want it?

Yes

No

Skinny (average size) is

Attractive

Unattractive