| The Questionnaires |
| Questionnaire 1 |
| What is your age? |
| Male or female? |
| Have you been diagnosed with scoliosis? |
| If yes, what treatment have your received? |
| If you have received more than one treatment, what is the other form of treatment you have received? |
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| 1. On the whole, I am satisfied with myself. |
| 2. At times, I think I am no good at all. |
| 3. I feel that I have a number of good qualities. |
| 4. I am able to do things as well as most other people. |
| 5. I feel that I do not have much to be proud of. |
| 6. I certainly feel useless at times. |
| 7. I feel that I'm a person of worth, at least on an equal plane with others. |
| 8. I wish I could have more respect for myself. |
| 9. All in all, I am inclined to feel that I am a failure. |
| 10. I take a positive attitude toward myself. |
| ***This page does not link to the other pages.*** |
| Questionnaire 2 |
| 1, On the whole, I am satisfied with myself. |
| 2. Other people consider me good looking. |
| 3. I'm proud of my body. |
| 4. I am preoccupied with trying to change my body weight. |
| 5. I think my appearance would help me
get a job. |
| 6. I like what I see when I look in the
mirror. |
| 7. There are lots of things I'd change about
my looks if I could. |
| 8. I am satisfied with my weight. |
| 9. I wish I looked better. |
| 10. I really like what I weigh. |
| 11. I wish I looked like someone else. |
| 12. People my own age like my looks. |
| 13. My looks upset me. |
| 14. I'm as nice looking as most people. |
| 15. I'm pretty happy about the way I look. |
| 16. I feel I weigh the right amount for my height. |
| 17. I feel ashamed of how I look. |
| 18. Weighing myself depresses me. |
| 19. My weight makes me unhappy. |
| 20. My looks help me to get dates. |
| 21. I worry about the way I look. |
| 22. I think I have a good body. |
| 23. I'm looking as nice as I'd like to.. |
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| **These all work using drop down menus for the choices. So, just click on the arrow at the right of the choice box and it will open the other options** |
| Instructions: Below is a list of statements dealing with your general feelings about yourself. If you strongly agree with the statement, select Strongly Agree from the drop down menu. If you agree, select Agree. If you diagree, select Disagree. If you strongly disagree, select Strongly Disagree. |
| Instructions: Select, from the drop down menu, how often you agree with the following statements, ranging from never to always. |
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| 3 Digit Number (From Consent Form) (Click top arrow first) |
| IF TEXT IS OVERLAPPING, EMAIL [email protected] |
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