Self-Image Survey 2 | QuestionPro

How many nights per week do you eat dinner with your family?

a. Never

b. Less than 3 nights per week

c. More than 3 nights per week

d. Every night

Has anyone ever made fun of you or made you feel self-conscious about your wieght/appearance?

a. Yes

b. No

Swimsuit season or wearing tight clothing makes you uncomfortable.

a. Strongly disagree

b. Disagree

c. Agree

d. Strongly agree

Do you ever feel like you can't participate in certain activities because of the way you look?

a. Yes

b. No

Roughly how many times do you look in the mirror per day?

a. Never

b. Only in the morning and at night

c. Morning, night, and in the bathroom at school

d. Every time you have the chance

If you are a boy, have you ever tried steroids or other enhancement drugs to bulk up your appearance? (If you are a girl, leave blank.)

a. Yes

b. No

If you are a girl, do you apply make-up everyday? (If you are a boy, leave blank.)

a. Yes, everyday

b. Occasionally

c. Never