Stress Management Assessment
On a scale 1-10:
Rate your sleep quality over the past month?
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On a scale 1-10:
How would you rate your mental clarity?
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On a scale 1-10:
Rate your ability to stay calm under pressure?
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On a scale 1-10:
How well can you focus on tasks without getting distracted by worries?
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On a scale 1-10:
Rate your energy levels throughout a typical day?
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Yes/No Questions (10 for yes, 0 for no):
Do you have a reliable way to decompress after a stressful day or event?
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Yes/No Questions (10 for yes, 0 for no):
Do you maintain healthy eating habits even when stressed?
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Yes/No Questions (10 for yes, 0 for no):
Do you have at least one person you can openly discuss your stress with?
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Yes/No Questions (10 for yes, 0 for no):
Do you engage in regular physical activity (at least 3 times per week)?
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Yes/No Questions (10 for yes, 0 for no):
Do you have daily practices that help you stay grounded?
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Name
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Phone
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Email
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I acknowledge that the information I provide will be used to help assess my current stress levels and determine the most appropriate support, programs, or services for my needs.
I Agree
