Body Perception Questionnaire

Explores how someone interprets the physical signals they notice from their body, along with their broader sense of body image.

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Full Name

First Name

Last Name

Age

Gender

Male Female Other

How satisfied are you with your overall body image?

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

What aspects of your body do you feel most positive about? (Select all that apply)

Face Body Shape Height Skin Hair Other

What aspects of your body do you feel least positive about? (Select all that apply)

Face Body Shape Height Skin Hair Other

Do you engage in any activities to improve your body image?

Yes No

If yes, please specify what activities you engage in

How often do you compare your body to others?

Always Often Sometimes Rarely Never

Do you think societal standards of beauty affect your body perception?

Yes No Not sure

Any additional comments or thoughts on body perception?

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