Questionnaire Version 1.01 engl.

Personal Data:

Full name:

Gender:
Male: Female:

Age:

Adress:

Phone:

Mail:

Nationalty:

How to fill the form:

Please give your opinion on each of the following statements by placing a mark to indicate if you
strongly agree (SA), agree (A), are uncertain (U), disagree (D) or strongly disagree (SD).

Questions SA A U D SD
I can easily follow actors in a movie
I often do not recognize people who I know
Some of my family have problems in recognizing faces
People often tell me I do not recognize them
I can decide immediately if a face is familiar
It takes me a long time to recognize people
I always recognize family members
I can easily find things which are not in the right place
I mostly recognize people by their voices
I can easily form a mental picture of a red rose
I can easily form pictures of close friends in my mind
I recognize famous people immediately
I sometimes recognize people I do not know
I can decide immediately whether a face is male or female
I can easily walk backwards in a room
I get lost in new places
I can see if a face is attractive
I can not easily read emotions in a face
I avoid meetings or parties as I might overlook familiar people
I do not recognize people the day after a brief meeting
IŽm very socialable


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