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  1. Surveys
  2. 2014
  3. January
  4. N
  5. Nervous behaviours
0%
Exit Survey
 
 
What are you?
 
Male
 
Female
 
Other
 
 
 
How old are you?
 
0-9
 
10-19
 
20-29
 
30-39
 
40-49
 
50-59
 
60-65+
 
 
 
On a scale of 1-10 how stressful do you find your life to be?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 
 
 
Do you have a history of anxiety or any mental illness?
 
Yes
 
No
 
 
 
Do you have any of these nervous habits? (Pick as many as apply)
 
Nail Biting
 
Licking lips
 
Chewing on lips or cheeks
 
Skin picking
 
Grinding teeth
 
Chewing on pens/items
 
Scratching
 
Popping knuckles
 
Rubbing eyes
 
Fidgiting
 
Pulling/Playing with hair
 
Other (please describe)
 

 
 
 
Have any of these nervous habits caused a physical problem or larger issue? (Weak hair from pulling, bleeding from picking, etc.)
 
Yes
 
No
 
 
 
If you answered yes to the previous question, please describe the issue.
   
 
 
 
Have these problems ever caused annoyance? (To yourself or from family members, friends, acquaintances.)
 
Yes
 
No
 
 
 
Do you feel that nervous habits are a negative thing?
 
Yes
 
No
 
Depends on the habit
 
 
 
Do you wish to end your nervous habit?
 
Yes
 
No