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ASSESS YOUR STRESS

ASSESS YOUR ANXIETY

Please rate your stress:

1: No Stress 2: Mild Stress 3: Moderate Stress 4: Very Stressed

How stressed do you feel today?

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How stressful has your job/work been?

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Have stressful have things been at home lately?

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4

How stressful is your financial situation?

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4

How stressed are you about losing your job?

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Are you having relationship stress?

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Have you been stressed about your health lately?

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Are you stressed about how things are going in your life right now?

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Are you dealing with any stressful issues at the moment?

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Thanks for submitting!

I will be in contact with you within 48 hours.

Please rate your anxiety:

1: Never 2: Sometimes 3: Often 4: Always

Racing heart/thoughts

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4

Shortness of breath

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Fear of dying

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Constant worry

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Unable to relax

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Feeling unreal

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Numbness/tingling

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4

Nervousness

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4

Sleeping/eating changes

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4

Avoiding situations

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4

Dizziness/lightheadedness

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4

Thanks for submitting!

I will be in contact with you within 48 hours.

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Assess Your Stress

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