Name
1) What is your name:
2) Do you feel that your name adequately suits you:
3) Would you change your name, and if so, why:
4) Would you be troubled if your children could not retain your surname:
Heritage
5) What is your ethnic heritage:
6) Do you easily identify with your ethnic heritage:
7) Have you ever felt persecuted or looked down upon because of your heritage:
Physical Aspects
8) Are you satisfied with your appearance:
9) Would you say that your appearance deviates from societal ideals:
10) Do you tend to believe that friends tell you that you are good looking only to avoid
hurting your feelings:
11) Have you ever felt superior or inferior to others because of your height:
Food
12) What is your favorite cuisine:
13) Do you prefer foods that have a familiar or exotic taste:
14) Would you be willing to try foreign delicacies that would be considered revolting in
your own country:
Music
15) What is your taste in music like:
16) Are you generally open to listening to new types of music, or are you very specific in
what you listen to:
17) If you had to pick a favorite band, which would it be, and why:
Clothing
18) What sort of clothing do you typically wear:
19) Is clothing an important outlet of expression for you:
20) Do you purposefully wear baggy clothing to conceal your figure, or wear revealing
clothing to make you more desirable:
Romance/Sexuality
21) Has your perception of a person’s physical appearance ever changed with your
opinion of them:
22) At any time in your life have you felt that you had not met any person worthy of your
romantic attention:
23) Would you prefer an extended, meaningful relationship, or a series of short, exciting
ones:
24) Have you ever felt that unrequited love was worth the suffering in order to have
somebody to want:
25) Does shallow physical intimacy make you feel wanted:
26) Does it mean something to you to feel wanted, even if you dislike the person who
feels that way towards you:
27) Would you enjoy being an object of desire:
Spirituality
28) Do you follow any form of organized religion:
29) If not, do you still believe in the possibility of higher powers:
30) Has faith ever helped you through trouble in life:
31) Does fear ever cause you to feel more faithful:
32) Have you ever felt persecuted for what you believe in: