Body Image Survey

Gender?

Male

Female

Do you have a postive or negative sense of your body image?

Positive

Negative

Is your appearance important to you?

Extremely Important

Very important

I don't care

No

Are you on a diet?

Yes

No

Do you think you have a healthy lifestyle?

Yes

No

More or less

How much do you exercise in a week?

1-2 hours a week

2-3 hours a week

3-4 hours a week

5 or more

Would you change your weight if you could do it instantly?

Yes

No

Maybe