Survey Templates Surveys QuestionPro Feature Survey (A) - COPIED [yqtsritkl

QuestionPro Feature Survey (A) - COPIED [yqtsritkl

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Each of the questions within this diary are answered on a scale, so for each question you can only choose one response. Remember to answer the questions based on your thoughts and feelings at this current moment. Also read each question carefully and be sure that you are checking the circle that is below your desired response. Finally, please be careful to check that you have answered all of the questions before summiting the diary

If you have any problems completing the diary refer to the instruction pages that you were provided with, if you are still having problems, please contact me using the details you have been given.

Please enter your participant ID

Please enter today's date and the number of this entry

Below is a list of statements dealing with your general feelings about yourself.

Please rate each individual statement based on how you feel at the present moment.

	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree
On the whole, I am satisfied with myself.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

At times, I think I am no good at all.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I feel that I have a number of good qualities.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I am able to do things as well as most other people.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I feel I do not have much to be proud of.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I certainly feel useless at times.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I feel that I’m a person of worth, at least on an equal plane with others.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I wish I could have more respect for myself.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

All in all, I am inclined to feel that I am a failure.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

I take a positive attitude toward myself.	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree

The following two sections show a list of statements dealing with your body image. Please rate each individual statement based on how you feel at the present moment.

	Not At All	A Little Bit	Somewhat	Very Much	Extremely
Do you think that parts of your body, like your thighs, hips or bottom are too large for the rest of you?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Are you afraid that you might have put on weight?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Are you worred about your flesh not being firm enough?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel so bad about your body that you feel like crying?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Are you worried about your thighs spreading out when sitting down?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel that you look excessively large and rounded?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel ashamed of your body?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Are you worried about other people seeing rolls of fat around your waist or stomach?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Are you worried about your flesh being dimply?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

	Not At All	A Little Bit	Somewhat	Very Much	Extremely
Do you feel that you look fat?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel that you look unattractive?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel dissatisfied with the appearance of specific areas of your body?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel that you look sexually appealing?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel good about your body?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel satisfied with your overall appearance?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel unhappy about your weight?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

Do you feel self-conscious about the way you look?	Not At All	A Little Bit	Somewhat	Very Much	Extremely

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QuestionPro Feature Survey (A) - COPIED [yqtsritkl

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