The name is absent

This is episode number......., which b

egan at.............and ended at.........

... .

8. Were you interacting with am
check the intensity of the intera

0) No one                  □

rone during the episode, and if y
ction!

in person on the phone EmailZChat

es, how? Please also

intense     quick

1) SpoiiseZpartner                □

□ □ □

□

□

2) your cluldreii                 □

(under age 10)

3) parents/

□ □ □

□

□

relatives                      □

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□

□

4) Iriends                        □

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□

5) co-workers                  □

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6) ClientsZcustomers              □

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□

□

7) boss                        □

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□

□

8) Other people (___________) □

Please specify!

9. How satisfied were you during

Not at all

0  12  3  4

10. How did you feel during this ep

□ □ □

his episode?

==□^=□^=□^=□-□=
5      6      7      8      9

ɪsode?

□        L

Very much

=□

10

Please rate each feeling on the scale given. A rating of 0 means that you did not experience that feeling at all.

A rating of 10 means dial this feeling was a very important part of the experience. Please check the Iiiunber that
best describes how you felt.

Not at all                                                            Very much

0        ɪ        2

3      4      5      6       7

S

9______10

IethargicZdull        □      □      □

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□

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enjoying myself    □     □     □

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□

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insecure/anxious     □      □      □

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□

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happy           □     □     □

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□

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IrustratedZamioyed □      □      □

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□

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relaxed            □     □     □

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□

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stressed            □      □      □

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□

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CoinfortableZat ease □      □      □

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