Body image questionnaire

1. What is your age range? Please tick one of the Boxes.

16-20 21-35 36-50 51-70 Older

2. What is your gender? Please tick one of the Boxes.

Male Female

3. What race/ethnicity are you? Please circle one of the answers.

White Black East Asian South Asian Middle Eastern/ Mixed Other
North African

4. On a scale of 1 to 10, how confident do you feel in your Body? Please circle a number.

1 2 3 4 5 6 7 8 9 10

Bad Ok Good

5. Do many Models in adverts appear unrealistic to you?

Yes No

6. If you answered “Yes” on question 5, how do you feel they are unrealistic?
Thank you for taking my questionnaire. I will keep your results anonymous.

Thanks, Annie.