Are you addicted to video games?

What is your age?

What is your sex?

Male

Female

Do you sometimes skip homework or work in order to play more video games?

Yes

No

Have you ever done poorly on a school assignment, test, or work assignment because you have spent so much time playing video games?

Yes

No

Do your parents/ guardian supervise your gameplay?

Have you ever stolen a video game from a store or a friend, or have you ever stolen money to buy a video game?

Yes

No

has your playing of video games negatively affected your school grades?

Not at all

A little

A lot

How long do you play video games every week?

Since playing video games I am (choose the one that most fits)

What game ratings do your parents allow you to play?