Marc Mulligan
Presentation & Workshop
Do It Today
Fear Survey
Thank you for taking the time to complete this survey.
It will only take a couple of minutes.
This survey is anonymous so please be as honest as possible.
The collated results will be posted on this website and used for further research.
1. Have you had or do you currently have any of the following fears or phobias?
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Arachnophobia (Spiders)
Acrophobia (Heights)
Agoraphobia (Open or crowded spaces)
Cynophobia (Dogs)
Claustrophobia (Small spaces)
Aerophobia (Flying)
Glossophobia (Public speaking)
Alektorophobia (Chickens)
Nyctophobia (The dark)
I have never had any fear of anything... ever
Tick more than one if required
Have you had or do you currently have a fear or phobia which is not listed above? Please explain.
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2. Have you ever overcome a fear? How did you do it?
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*
Indicates required field
3. Would you like to overcome your fear or phobia?
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Yes
No
I don't have any fears or phobias
4. Have you ever feared that something bad would happen but it did not happen? Please describe.
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5. Have you had or do you currently have a fear that you think is unusual? ie. Fear of knees / Fear of apricots
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6. Do you remember a time when fear prevented you from doing something that you wanted to do?
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Yes
No
I can't remember
7. Do you think it is possible to overcome any fear or phobia?
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Yes
No
Yes, but I don't know how
Yes but it takes effort
It's not worth trying
I don't know
8. In your opinion, what would be potentially the worst or most disruptive fear or phobia that a person could suffer from?
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Arachnophobia (Spiders)
Acrophobia (Heights)
Agoraphobia (Open or crowded spaces)
Claustrophobia (Small spaces)
Xanthophobia (The colour yellow)
Arithmophobia (Numbers)
Genuphobia (Knees)
Alliumphobia (Garlic)
What is your age?
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Less than 13
13-18
19-25
26-35
36-50
51 - 65
Over 65
Prefer not to say
Please select your gender:
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Female
Male
Which country are you from?
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Please select one
Australia
Canada
China
France
Germany
Hungary
India
Indonesia
Ireland
Italy
The Netherlands
Nigeria
The Philipines
Poland
Portugal
Russia
Spain
United States
U.K.
Somewhere not on this list
Prefer not to say
If you are from a country not listed, please enter your country below.
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