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Surveys
2014
January
N
Nervous behaviours
Nervous behaviours
0%
Exit Survey
What are you?
Male
Female
Other
How old are you?
0-9
10-19
20-29
30-39
40-49
50-59
60-65+
On a scale of 1-10 how stressful do you find your life to be?
1
2
3
4
5
6
7
8
9
10
Do you have a history of anxiety or any mental illness?
Yes
No
Do you have any of these nervous habits? (Pick as many as apply)
Nail Biting
Licking lips
Chewing on lips or cheeks
Skin picking
Grinding teeth
Chewing on pens/items
Scratching
Popping knuckles
Rubbing eyes
Fidgiting
Pulling/Playing with hair
Other (please describe)
Have any of these nervous habits caused a physical problem or larger issue? (Weak hair from pulling, bleeding from picking, etc.)
Yes
No
If you answered yes to the previous question, please describe the issue.
Have these problems ever caused annoyance? (To yourself or from family members, friends, acquaintances.)
Yes
No
Do you feel that nervous habits are a negative thing?
Yes
No
Depends on the habit
Do you wish to end your nervous habit?
Yes
No
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