1) How well do you like the appearance of your nose | Not at all (0) Somewhat (1) Moderately (2) Very much (3) Completely (4) |
2) How well are you able to breathe through your nose | Not at all (0) Somewhat (1) Moderately (2) Very much (3) Completely (4) |
3) How much do you feel your friends and loved ones like your nose | Not at all (0) Somewhat (1) Moderately (2) Very much (3) Completely (4) |
4) Do you think your current nasal appearance limits your social or professional activities | Always (0) Usually (1) Sometimes (2) Rarely (3) Never (4) |
5) How confident are you that your nasal appearance is the best that it can be | Not at all (0) Somewhat (1) Moderately (2) Very much (3) Completely (4) |
6) Would you like to surgically alter the appearance or function of your nose | Definitely (0) Most likely (1) Possibly (2) Probably not (3) No (4) |