Full Name
Email
*
1. Do you quite often feel the urge to go shopping when you are low or depressed?
*
YES
NO
2. Do you frequently walk away from a store with many more purchases than you had intended to make?
*
YES
NO
3. Are your credit cards almost to their limit or maxed out?
*
YES
NO
4. Are you unable to resist a sale or a bargain?
*
YES
NO
5. Do you ignore family or work responsibilities so you can go shopping?
*
YES
NO
6. Do you spend more than you earn?
*
YES
NO
7. Do you buy things hoping that it will make you feel more like your ideal image?
*
YES
NO
8. Do you purchase items that you’ll never use?
*
YES
NO
9. Do you shop alone, with friends or family?
*
alone
friends
family
other