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Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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Survey - thank you for your time
1
Do you feel self-conscious about how you sound or look when speaking in front of others?
Select one or more answers
Not at all
Slightly
Moderately
Extremely
2
Do you feel like everyone is watching you when you walk somewhere alone (e.g. into a café, shop)?
Select one or more answers
Not at all
A little
quite a lot
very much so
3
Do you avoid eye contact or try to look busy (e.g. looking at your phone) when walking into a room full of people?
Select one or more answers
Never
Sometimes
Often
Always
4
Do you rehearse what you are going to say before making a phone call, such as booking an appointment?
Select one or more answers
Never
Sometimes
Often
Always
5
Have you ever avoided a situation (like asking for help or returning an item) because you were worried you might look silly or be judged?
Select one or more answers
Yes
No
6
Do you think it's okay to use some “safety behaviours” (like preparing, avoiding eye contact) if they help you get through social situations?
Select one or more answers
Yes
No
7
Have you ever replayed something you said in your head afterwards, worrying how you came across?
Select one or more answers
Never
Occasionally
Often
All the time
8
Do you prefer having someone with you when you go into unfamiliar places (like a new restaurant or gym)?
Select one or more answers
Yes
No
Depends upon the place
9
Do you ever feel like even small social situations (like chatting with a stranger or receptionist) can take a lot of mental energy?
Select one or more answers
Yes
No
Sometimes
10
Do you feel more confident when you're with friends / family than when you're on your own in public?
Select one or more answers
Always
Most of the time
Sometimes
Rarely
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