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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?
How stressful has your job/work been?
Have stressful have things been at home lately?
How stressful is your financial situation?
How stressed are you about losing your job?
Are you having relationship stress?
Have you been stressed about your health lately?
Are you stressed about how things are going in your life right now?
Are you dealing with any stressful issues at the moment?

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
Shortness of breath
Fear of dying
Constant worry
Unable to relax
Feeling unreal
Numbness/tingling
Nervousness
Sleeping/eating changes
Avoiding situations
Dizziness/lightheadedness

Thanks for submitting!

I will be in contact with you within 48 hours.

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