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Suggestibility Scale
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Email*
Name*
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Occupation*
Date Of Birth
Would you prefer your consultation ? *
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What is your preference for days? *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What are your preferences for timings? *
10 am to 1 pm
2 pm to 5 pm
6 pm to 8 pm
1. Have you ever walked in your sleep during your adult life? *
Yes
No
2. As a teenager did you feel comfortable expressing your feelings to one or both of your parents or friends? *
Yes
No
3. Do you have a tendency to look directly into a person's eyes and /or move closely to them when discussing an interesting subject? *
Yes
No
4. Do you feel that most people, when you first meet them, are uncritical of your appearance? *
Yes
No
5. In a group situation, with people that you have just met, would you feel comfortable drawing attention to yourself by initiating a conversation? *
Yes
No
6. Do you feel comfortable holding hands or hugging someone you are in a relationship with in front of other people? *
Yes
No
7. When someone talks about feeling warm physically, do you begin to feel warm also? *
Yes
No
8. Do you tend to occasionally tune out when someone is talking to you because you are anxious to come up with your side, and at times not hear what the other person said? *
Yes
No
9. Do you feel that you learn and comprehend better by seeing and/or reading than by hearing? *
Yes
No
10. In a new class or lecture situation do you usually feel comfortable asking questions in front of the group? *
Yes
No
11. When expressing your ideas do you find it important to relate all the details leading up to the subject so the other person can understand it completely. *
Yes
No
12. Do you enjoy relating to children? *
Yes
No
13. Do you find it easy to be at ease and comfortable with your body movements, even when faced with unfamiliar people and circumstances? *
Yes
No
14. Do you prefer reading fiction rather than non-fiction? *
Yes
No
15.If you were to imagine sucking on a sour, bitter, juicy, yellow lemon, would your mouth water? *
Yes
No
16. If you feel that you deserve to be complimented for something well done, do you feel comfortable if the compliment is given to you in front of other people? *
Yes
No
17. Do you feel that you are a good conversationalist? *
Yes
No
18. Do you feel comfortable when complimentary attention is drawn to your physical body or appearance? *
Yes
No
Questionnaire 2
1. Have you ever awakened in the middle of the night and felt that you could not move your body and or talk? *
Yes
No
2. As a child did you feel that you were more affected by the tone of voice of your parents than by what they actually said? *
Yes
No
3. If someone you are associated with talks about a fear that you too have experienced, do you have a tendency to have an apprehensive or fearful feeling also? *
Yes
No
4. After having an argument with someone, do you have a tendency to dwell on what you could or should have said ? *
Yes
No
5. Do you tend to occasionally tune out when someone is talking to you and do not hear what was said because your mind drifts to something totally unrelated? *
Yes
No
6. Do you sometimes desire to be complimented for a job done well done, but feel embarrassed or uncomfortable when complimented? *
Yes
No
7. Do you often have a fear or dread of not being able to carry on a conversation with someone you just met? *
Yes
No
8. Do you feel self conscious, when attention is drawn to your physical body or appearance? *
Yes
No
9.If you have a choice, would you rather avoid being around children most of the time? *
Yes
No
10. Do you feel that you are relaxed or loose in body movement, especially when faced with unfamiliar people or circumstances? *
Yes
No
11. Do you prefer reading non-fiction rather than fiction? *
Yes
No
12. If someone describes a very bitter taste, do you have difficulty experiencing the physical feeling of it? *
Yes
No
13. Do you generally feel that you see yourself less favorably than others see you? *
Yes
No
14. Do you tend to feel awkward or self- conscious initiating touch ( holding hands, kissing, etc.) with someone you are in relationship with in front of other people? *
Yes
No
15. In a new class or lecture situation do you usually feel comfortable asking questions in front of group even though you may desire further explanation? *
Yes
No
16. Do you feel uneasy if someone you have just met looks directly in the eyes when talking to you, especially if the conversation is all about you? *
Yes
No
17. In a group situation with people you have just met, would you feel uncomfortable drawing attention to yourself by initiating a conversation? *
Yes
No
18. If you are in a relationship, or are very close to someone, do you find it difficult or embarrassing to verbalize your love for them? *
Yes
No