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Questions marked with a * are required Exit Survey
 
 
How old were you when you first made a social media account?
   
 
 
How do you feel about your...
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Weight
-
Hair
-
Face
-
Teeth
-
Arms
-
Breasts/Chest
-
Belly
-
Waist/Hips
-
Legs
-
Body (overall)
-
 
 
 
How often do you use social media sites?
 
Never
 
Once every few days
 
Once every couple of days
 
Once a day
 
One hour a day
 
2-3 hours a day
 
3-5 hours a day
 
5 or more hours a day
 
 
 
How many times a day do you see an image on social media sites that makes you reflect personally on your own body and shape?
 
 
None
 
1-3 times a day
 
4-6 times a day
 
7-10 times a day
 
10-15 times a day
 
15+ times a day
 
 
 
* What is your gender
 
 
 
* How old are you?
 
17-19
 
20-22
 
23-25
 
26-28
 
29-31
 
32-34
 
35 or older
 
 
 
 Do you currently use any social media sites?
 
 
 
Which social media sites do you use? (Select all that apply)?
 
Facebook
 
Instagram
 
Twitter
 
Pintrest
 
Tumblr
 
Tinder
 
Snapchat
 
Other
 

 
 
 
Does seeing images on social media make you feel insecure about your body?
 
Yes
 
No
 
Other