Body Image Survey

Age

Gender

male

female

Other (please specify)

How important to you is your appearance?

very important

moderately important

slightly important

not important

Generally, do you have a positive or negative view of your body image?

positive

negative

neutral

How often do you have negative thoughts about your body?

never or almost never

once or twice a month

one or twice a week

once or twice a day

more than a few times every day

When do you feel the best about your body?

when dressed up or dressed well

after a workout or physical activity

after receiving a compliment

Other (please specify)

Do you think you look better naked or clothed?

naked

clothed

How does your body image affect your sex life?

I worry a lot about the way I look and how my partner thinks I look

the way my body looks is sometimes in the back of my mind during sex

I think about it, but in a good way, because I know it is attractive

I don't think about my appearance during sex

not sexually active at this time

Do you feel that pressure related to body image affects you?

yes

no (skip to question 11)

What is the biggest cause of pressure related to your body image?