Self Image Questionnaire

This questionnaire is designed to help you assess your current self-image. Answer each question honestly, selecting the response that best describes your thoughts and feelings. At the end, tally up your score to see where your self-image stands.

First Name *

Last Name *

Email *

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How do you feel when you look in the mirror? *

I see someone confident and attractive

I’m neutral; I don’t think much about it

I often focus on flaws or things I’d like to change

I avoid looking in the mirror because it makes me uncomfortable

When you face a new challenge, what is your typical reaction? *

I’m excited and confident that I’ll succeed

I’m a bit nervous but willing to give it a try

I doubt my abilities but push through anyway

I often think I’m not capable and avoid it if possible

How do you respond to compliments? *

I accept them graciously and believe them

I’m thankful but don’t fully believe them

I feel awkward and unsure how to respond

I dismiss them or think the person is just being polite

What do you believe about your potential for success? *

I believe I have unlimited potential and can achieve anything

I believe I have potential but need to work hard to unlock it

I’m unsure if I’ll ever reach my full potential

I often feel like I’m not meant to succeed

How often do you compare yourself to others? *

Rarely, I focus on my own journey

Sometimes, but I try not to let it affect me

Often, I find myself wishing I was more like others

Constantly, I always feel like I’m not good enough

How would you describe your inner dialogue? *

Positive and encouraging

Mostly neutral with occasional negativity

Often critical and doubting

Mostly negative and harsh

How do you approach your goals and aspirations? *

I set ambitious goals and work confidently towards them

I set realistic goals and work steadily towards them

I set small goals, fearing failure if I aim too high

I avoid setting goals because I doubt I’ll achieve them

What is your general outlook on life? *

Optimistic, I believe good things are always on the horizon

Cautiously optimistic, with some concerns

Pessimistic, I often expect things to go wrong

Negative, I rarely believe things will turn out well

How do you feel about your past mistakes? *

I see them as valuable lessons that have helped me grow

I try to learn from them but sometimes dwell on them

I often feel ashamed or regretful about them

I constantly beat myself up over past mistakes

When others achieve success, how do you react? *

I feel genuinely happy for them and inspired by their success

I’m happy for them but feel a bit envious

I feel envious and wonder why I can’t achieve the same

I feel resentful and think it’s unfair