1 – Not At All
2 – Slightly
3 – Moderately
4 – Very
5 – Extremely
¹
1
2
3
4
5
1
I am concerned about what other people think of my appearance.
2
It bothers me if I know someone is judging my physical shape.
3
I worry that people will find fault with the way I look.
4
When I meet new people, I wonder what they think about my appearance.
5
I am afraid other people will notice my physical flaws.
6
I think that other people's opinions of my appearance are too important to me.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.