Stress Assessment

HealoMax Stress Assessment

Please answer the following questions on a scale of 1-5:

1. Do you feel: Overwhelmed/ Less Enjoyment or Energy/ Frequent Cold or Pains ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

2. Increased forgetfulness or confusion or disorientation / poor decision making ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

3. Depending drugs or excessive use of alcohol or caffein or smoking ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

4. Procrastination or avoidance/ decreased self esteem or self care ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

5. Do you feel: Irritable or Angry/ Less Compassionate to others ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

6. Do you feel lonely or isolated or helpless or hopeless ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

7. Decreased concentration or repeated mistakes ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

8. Are you Constantly worried or restless ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

9. Any changes in your sleep pattern ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

10. Eating excessive or insufficient ? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often