Self Confidence Survey
Please indicate your gender
Female
Male
Other
Please indicate your age
Are you satisfied with your life?
Very Satisfied
1
2
3
4
5
6
Very Dissatisfied
7
1 is Very Satisfied, 7 is Very Dissatisfied
Do other people say that you are a moody person?
Yes
No
Do you lie awake at nights worrying about things?
Yes
No
How often do you let insecurity interfere with decisions?
Never
1
2
3
4
5
6
Often
7
1 is Never, 7 is Often
Would you consider yourself attractive?
Yes
No
Why?
What is the biggest source of pressure in your life?
Society
Friends
Family
School / Work
Yourself
Other
Please specify
Would you be easily upset?
Yes
No
Are you easily hurt if you are criticised?
Yes
No
Do you easily. become irritable with people?
Yes
No
Do you think your life will.....?
Get Better
Stay the same
Get Worse
I don't know
Submit
Should be Empty: