This document contains a questionnaire about the effects of taking selfies. The questionnaire is divided into two sections: demographics and psychographics. The demographics section collects gender and education information. The psychographics section contains 17 questions about attitudes toward selfies on a scale ranging from strongly agree to strongly disagree to neutral. Respondents are asked their level of agreement with statements about whether selfies can affect mental state, promote self-inferiority, and increase selfishness.