Problem Video Game Playing Questionnaire Form
Please complete the Problem Video Game Playing Questionnaire to help assess your gaming habits and their effects. All responses are confidential and used only for self-reflection or research purposes.
How often do you play video games?
*
Daily
Several times a week
Once a week
A few times a month
Rarely/Never
On average, how many hours per day do you spend playing video games?
*
Less than 1 hour
1-2 hours
2-4 hours
4-6 hours
More than 6 hours
Have you ever tried to cut back on your video game playing but were unsuccessful?
*
Yes
No
How often do you think about playing video games when you are not playing?
*
Very often
Often
Sometimes
Rarely
Never
Have your gaming habits negatively affected your school, work, or relationships?
*
Yes, frequently
Yes, occasionally
No
How do you feel if you are unable to play video games for an extended period?
*
Very upset or anxious
Somewhat upset
Neutral
Not bothered
Have you ever lost track of time while playing video games?
*
Often
Sometimes
Rarely
Never
Which of the following have you experienced due to gaming? (Select all that apply)
*
Sleep issues
Neglected responsibilities
Arguments with others
Decline in academic or work performance
None of the above
Other
How would you rate your overall satisfaction with your current gaming habits?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Please share any additional comments about your video game playing habits.
Submit
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