Survey
The information that is received in this survey will be used only for study and statistical purposes. Please answer all questions as you as the participant will remain anonymous.
1) How old are you?___________________
2) Are you happy with you body image? Yes/ No
3) If answered No, please state why?
______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4) If you could change anything about yourself, what would you change?
Hair Nose Freckles Skin Tone Eyes
Body Build Nothing, I am happy with myself.
Other (Please state) ____________________________________________________
5) Do you read ‘Female’ aimed magazines? Yes/No
6) If answered yes, please circle which ones:
Dolly Cosmopolitan Vogue Girlfriend Cleo
Grazier Other (please state)______________________________________
7) Do you compare yourself to the models in these said magazines? Yes/No
8) Are you intimidated by the models in the magazines? Do you feel you need to look like them? Yes/No
9) Do you buy the style of clothing that is promoted in the magazines at the time? Yes/No
10) Have you ever been bullied because of your body image? Yes/ No
11) If Yes, How did it make you feel? _____________________________________________
______________________________________________
______________________________________________
_______________________________________________
_______________________________________________
__________________________________
12) Has the media such as magazines, TV shows, weight loss program flyers etc influenced you to lose weight? Yes/ No
13) If yes, please state why? ____________________________________________________
_______________________________________________________
______________________________________________________
________________________________________________________
14) Have you ever been on a diet before? Yes/No
15) If answered yes, why did this diet occur? _______________________________________
________________________________________
_________________________________________
_________________________________________
__________________________________________
________________________________________________________
16) Do movies such as “Devil wears Prada” and “Suddenly 30” influence your perception of what is accepted within our modern say society as a ‘perfect body image’?
Yes/ No/ I have not viewed these movies before
17) If answered yes, please state why? _____________________________________
_______________________________________________________
________________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________________
18) Does the way you look effect your self esteem? Yes/ No
19) If answered yes, Please state why?__________________________________________
__________________________________
Thankyou for your participation.
The information that is received in this survey will be used only for study and statistical purposes. Please answer all questions as you as the participant will remain anonymous.
1) How old are you?___________________
2) Are you happy with you body image? Yes/ No
3) If answered No, please state why?
______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4) If you could change anything about yourself, what would you change?
Hair Nose Freckles Skin Tone Eyes
Body Build Nothing, I am happy with myself.
Other (Please state) ____________________________________________________
5) Do you read ‘Female’ aimed magazines? Yes/No
6) If answered yes, please circle which ones:
Dolly Cosmopolitan Vogue Girlfriend Cleo
Grazier Other (please state)______________________________________
7) Do you compare yourself to the models in these said magazines? Yes/No
8) Are you intimidated by the models in the magazines? Do you feel you need to look like them? Yes/No
9) Do you buy the style of clothing that is promoted in the magazines at the time? Yes/No
10) Have you ever been bullied because of your body image? Yes/ No
11) If Yes, How did it make you feel? _____________________________________________
______________________________________________
______________________________________________
_______________________________________________
_______________________________________________
__________________________________
12) Has the media such as magazines, TV shows, weight loss program flyers etc influenced you to lose weight? Yes/ No
13) If yes, please state why? ____________________________________________________
_______________________________________________________
______________________________________________________
________________________________________________________
14) Have you ever been on a diet before? Yes/No
15) If answered yes, why did this diet occur? _______________________________________
________________________________________
_________________________________________
_________________________________________
__________________________________________
________________________________________________________
16) Do movies such as “Devil wears Prada” and “Suddenly 30” influence your perception of what is accepted within our modern say society as a ‘perfect body image’?
Yes/ No/ I have not viewed these movies before
17) If answered yes, please state why? _____________________________________
_______________________________________________________
________________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________________
18) Does the way you look effect your self esteem? Yes/ No
19) If answered yes, Please state why?__________________________________________
__________________________________
Thankyou for your participation.