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Questionnaire on COVID's Effects
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CONSENT FORM
Click the link below to access the form. When you sign below, you agree to the conditions and are volunteering to participate.
https://docs.google.com/document/d/1dg8X1XMAM96Q8AG_noPm8t31mWdvfWTAEEAPcgvDFGo/edit?usp=sharing
If you agree to the consent form, please check the box below and the attributes along with it.
*
By checking this box, you are consenting the use of your information to conduct a study on COVID 19's impact
Required
Please check this box if your are under 18 and have a parental permission
By checking this box, your parent/guardian is allowing you to fill out this form for the study.
What is the date?
*
MM
/
DD
/
YYYY
Check this once you have completed the form.
*
I have checked the form
Required
What grade are you in?
*
Freshman
Sophomore
Junior
Senior
Freshman (in college)
Sophomore (in college)
Junior (in college)
Senior (in college)
What race do you identify with?
*
White
African-American
Hispanic/Latino
AAPI
Other:
What gender do you identify with?
*
Male
Female
Non-binary
Prefer not to say
Other:
What was your estimated body weight before COVID?
*
Your answer
What is your estimated body weight now?
*
Your answer
What was your estimated height before COVID?
*
Your answer
What is your estimated height now?
*
Your answer
Do you count calories?
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Yes
No
Sometimes
How much did you think about your body image before COVID?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How much do you think about your body image now?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How comfortable do you feel eating in public?
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Very uncomfortable
1
2
3
4
5
6
7
8
9
10
Very comfortable
How much did weight gain concern you before COVID?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How much does weight gain concern you now?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How satisfied are you with your weight?
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Very unsatisfied
1
2
3
4
5
6
7
8
9
10
Very satisfied
How much guilt did you feel after enjoying good food before COVID?
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None
1
2
3
4
5
6
7
8
9
10
A lot
How much guilt do you feel after enjoying good food now?
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None
1
2
3
4
5
6
7
8
9
10
A lot
How much did you care about others' opinions on your body before COVID?
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None
1
2
3
4
5
6
7
8
9
10
A lot
How much do you care about others' opinions on your body now?
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None
1
2
3
4
5
6
7
8
9
10
A lot
Did you ever think to practice diets or other strategies to lose weight before COVID?
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Yes
No
Sometimes
Do you ever think about practicing diets or other strategies to lose weight now?
*
Yes
No
Sometimes
Did you ever implement an excessive, rigid exercise regimen - despite weather, fatigue, illness, or injury before COVID?
*
Yes
No
Sometimes
Do you ever implement an excessive, rigid exercise regime - despite weather, fatigue, illness, or injury now?
*
Yes
No
Sometimes
Did you have any food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate) before Covid?
*
Yes
No
Sometimes
Do you have any food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate) now?
*
Yes
No
Sometimes
Did you ever feel episodes of loneliness before COVID?
*
Yes
No
Sometimes
Are your episodes of loneliness increased or decreased now?
*
Increased
Decreased
How much did you feel uncertain about your future before COVID?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How much do you feel uncertain about your future now?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How picky were you to food before COVID?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
How picky are you now?
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Not at all
1
2
3
4
5
6
7
8
9
10
A lot
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Feeling nervous, anxious, or on edge
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Not at all
0
1
2
3
Nearly everyday
Not being able to stop or control worrying
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Not at all
0
1
2
3
Nearly everyday
Worrying too much about different things
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Not at all
0
1
2
3
Nearly everyday
Trouble relaxing
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Not at all
0
1
2
3
Nearly everyday
Being so restless that it is hard to sit still
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Not at all
0
1
2
3
Nearly everyday
Becoming easily annoyed or irritable
*
Not at all
0
1
2
3
Nearly everyday
Feeling afraid as if something awful might happen
*
Not at all
0
1
2
3
Nearly everyday
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