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What was your favorite part about the magazine?
   
What was your least favorite part about the magazine?
   
Would you want to prescribe the receive this magazine monthly?
   
Do you think other people you know would like this magazine?
   
 
 
Please select how often you do the following?
Never Rarely Sometimes Often Always
Look at or read beauty/ fashion magazines
Look at or read health/ fitness magazines
Look at or read news magazines
 
 
How often do you do the following
Never Rarely Sometimes Often Always
Compare your body to others bodies
compare your body to celebrity’s bodies
Compare your body to models
Workout
 
 
How satisfied are you with your body image?
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
 
 
 
Are you a healthy eater?
Strongly agree Agree Neutral Disagree Strongly disagree
 
 
 
 
Have you ever thought about becoming anorexic or bulimic in order to achieve a certain weight?
 
Yes
 
No
 
Not sure
 
 
Is your body image important to you?
Strongly agree Agree Neutral Disagree Strong disagree
 
 
 
Do you feel pressured to be thin?
Yes No Not sure
 
 
 

Do you think the images we see in magazines today directly effect how we feel about ourselves?
Strongly agree Agree Neutral Disagree Strongly disagree
 
 
 
Please read each item and indicate how you feel about this part or function of your own body using the following scale:
1 = Have strong negative feelings
2 = Have moderate negative feelings
3 = Have no feeling one way or another
4 = Have moderate positive feelings
5 = Have strong positive feelings
1 2 3 4 5
nose

physical stamina
reflexes
lips
muscular strength
waist
energy level 

thighs
ears
biceps
1 2 3 4 5
chin
physical coordination 

buttocks
chest or breasts 

cheeks/cheekbones
hips
legs
figure or physique
appearance of stomach
face

weight