Q1: I feel guilty when I slow down or rest. *

Rarely

Sometimes

Often

Almost Always

Q2: I often feel emotionally exhausted even when I appear “fine” to others. *

Rarely

Sometimes

Often

Almost Always

Q3: I struggle to relax because my mind constantly feels “on.” *

Rarely

Sometimes

Often

Almost Always

Q4: I feel disconnected from joy, peace, or genuine rest. *

Rarely

Sometimes

Often

Almost Always

Q5: I struggle to set boundaries because I do not want to disappoint people. *

Rarely

Sometimes

Often

Almost Always

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First Name *

Last Name *

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Phone

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