1 How well do you like the appearance of your chin? | |||||
Not at all 1 | Somewhat 2 | Moderately 3 | Very 4 | Extremely 5 | N/A 0 |
2 How much do you feel your friends and loved ones like the appearance of your chin? | |||||
Not at all 1 | Somewhat 2 | Moderately 3 | Very 4 | Extremely 5 | N/A 0 |
3 Do you feel the current appearance of your chin limits your social or professional activities? | |||||
Not at all 1 | Somewhat 2 | Moderately 3 | Very 4 | Extremely 5 | N/A 0 |
4 How confident are you that the appearance of your chin is the best it can be? | |||||
Not at all 5 | Somewhat 4 | Moderately 3 | Very 2 | Extremely 1 | N/A 0 |
5 Would you like to surgically alter the appearance of your chin? | |||||
Not at all 5 | Somewhat 4 | Moderately 3 | Very 2 | Extremely 1 | N/A 0 |