Any person, both young and old can fill up the body image satisfaction questionnaire in order to form an idea about what they think of themselves, their figure and body structure. These types of questionnaires help to find out the overall satisfaction with one’s body image.

Sample Body Image Satisfaction Questionnaire

Name: ____________________________________________________________

Address: __________________________________________________________

Date of birth: ¬__________________ Sex: Male / Female

Contact number: _______________________ Email Address: ____________________

Today’s date: ___________________

Please choose the correct options

1. According to you does the physical appearance of a person matters how people conceive them?

a. Yes to a great extent

b. Yes, to some extent

c. No, it all depends upon the nature of the person

2. According to your opinion, you are

a. Very fat

b. Fat

c. Normal weight

d. Slim

e. Very thin

3. Do your family members and friends think that you are thin?

a. Yes, they say that I am emaciated

b. Yes, they say I should exercise and build up my muscle bulk

c. Not at all

4. According to the opinion of your friends and family members are you fat?

a. They are always complaining about how much weight I have managed to put on.

b. No, they do not comment anything about it.

5. If one is thin, then he or she should

a. Feel better about oneself

b. Be very strong

6. If one is quite fat, then he or she should

a. Be quite weak and sloth

b. Feel bad about oneself

7. Do you exercise regularly to keep yourself fit and healthy?

a. Yes

b. No

c. At times