Full Name *

Email *

Instructions

1- Focus on a particular environment (i.e home, Work etc)

2- Chose one letter for each statement that best describes your feelings. Please answer each statement honestly

Profile Response Codes

N= Never or almost never

R= Rarely

S= Sometimes

O= Often

A= Always or Almost Always

Stress Statements

There are times when I find it hard to be myself *

N

R

S

O

A

I am a happy and contented person *

N

R

S

O

A

I worry about the outcome of events *

N

R

S

O

A

I have the energy and endurance I need *

N

R

S

O

A

I feel motivated to accomplish things *

N

R

S

O

A

I feel sad and "down in the dumps" *

N

R

S

O

A

I feel in control of my eating habits *

N

R

S

O

A

I feel sluggish and lack energy *

N

R

S

O

A

I feel loved by someone is important to me *

N

R

S

O

A

I accomplish things that I feel are important *

N

R

S

O

A

My life is not simulating *

N

R

S

O

A

I have stomach trouble *

N

R

S

O

A

I feel well-organized and think clearly *

N

R

S

O

A

I get what I want *

N

R

S

O

A

I am comfortable with the people around me *

N

R

S

O

A

I am resentful about things that have happened to me in the past *

N

R

S

O

A

I feel physically strong and capable *

N

R

S

O

A

I am in conflict between how I think I should be and how I am *

N

R

S

O

A

Day to day living is boring for me *

N

R

S

O

A

I have guilt feelings about eating *

N

R

S

O

A

I think I am living a fulfilling life *

N

R

S

O

A

I have difficulty keeping my mind under control *

N

R

S

O

A

I feel excluded or rejected by people *

N

R

S

O

A

I long for a chance to start over again *

N

R

S

O

A

I feel peaceful *

N

R

S

O

A

I feel lonely *

N

R

S

O

A

I have a clear conscience *

N

R

S

O

A

I have aches and pains *

N

R

S

O

A

I have the standard of living I feel I deserve *

N

R

S

O

A

I have peasant feelings *

N

R

S

O

A

It's difficult for me to get close to people *

N

R

S

O

A

I worry about my weight *

N

R

S

O

A

I have feelings of belonging *

N

R

S

O

A

I feel as though I am part of a family *

N

R

S

O

A

My life is boring and lacks excitement *

N

R

S

O

A

I feel that things which happen to me are not fair *

N

R

S

O

A

I remember things that are important *

N

R

S

O

A

I feel nervous and uptight *

N

R

S

O

A

I feel good about my eating habits *

N

R

S

O

A

I enjoy having people around me *

N

R

S

O

A

NEXT

Showing 1 of 40