chloe--xox
New Member
- Joined
- Mar 18, 2007
- Messages
- 6
- Gender
- Female
- HSC
- 2007
Age □ 13 □ 16
□ 14 □ 17
□ 15 □ 18
1/ Do you think you are:
a/ □Too thin □Too fat □Just Right
b/ □Too Tall □Too short □Just Right
c/ □Attractive □Unattractive □Average
2/ Are you happy with your body and the way you look?
□Always □Sometimes □Never
3/ Have you ever disliked your body and appearance?
□Always □Sometimes □Never
4/ Do you ever overly worry or obsess about your body?
□Always □Sometimes □Never
5/ Have you ever tried to lose weight?
□Yes □No
6/ Have you ever been on a diet? (Voluntarily)
□Yes □No
If yes, how many?
□ 1
□ 2-3
□ 4-5
□ 5+ PLEASE TURN
7/ Have you ever felt you should be on a diet?
□Always □Sometimes □Never
8a/ Would you ever consider plastic surgery?
□Yes □No
8b/ If yes, what would you get done and why? _______________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________
9a/ Is there anything you would change about your body?
□Yes □No
9b/ If yet please state ___________________________________________________
9c/ What are your reasons for wanting the change?_______________________­­­­­­_____
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
10a/ Do you think there is too much pressure on teenage girls to be thin?
□Yes □No
10b/ If yes, where are these pressures coming from? ___________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
11/ Any other comments? _______________________________________________
__________________________________________________________________________________________________________________________________________
_____________________________________________________________________