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Self Esteem Questionnaire
Self Esteem Questionnaire. Please help by completing this and sending back to us. It is completely anonymous.
Gender:
*
select...
Female
Male
Age:
*
select...
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65
66 - 70
70+
Profession:
*
Where do you rate your self esteem on a scale of 0 - 10, where 0 is no self esteem at all.:
*
select...
0
1
2
3
4
5
6
7
8
9
10
What affects your self esteem?:
*
1. If I was wrong or made mistakes at work
2. My financial situation
3. When I am not perfect
4. Body shape and size
5. If I am uncertain
6. If I am out of control
7. Success in my work/profession
8. Whether someone I like finds me attractive
9. Whether I feel attractive or not
10. Being in happy relationship
11. When I think I have failed
12. If I am not as slim as I want
13. If I have the lifestyle I want
14. Failure in my work/profession
15. Whether people like me or not
16. Getting rejected by someone I like
17. When I do not achieve what I want
18. Being single
19. When I am criticised or unappreciated
20. Other (Please specify below)
Other: