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AZ STRESS & ANXIETY RELIEF

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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?

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2

3

4

How stressful has your job/work been?

1

2

3

4

Have stressful have things been at home lately?

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2

3

4

How stressful is your financial situation?

1

2

3

4

How stressed are you about losing your job?

1

2

3

4

Are you having relationship stress?

1

2

3

4

Have you been stressed about your health lately?

1

2

3

4

Are you stressed about how things are going in your life right now?

1

2

3

4

Are you dealing with any stressful issues at the moment?

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4

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

1

2

3

4

Shortness of breath

1

2

3

4

Fear of dying

1

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3

4

Constant worry

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4

Unable to relax

1

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4

Feeling unreal

1

2

3

4

Numbness/tingling

1

2

3

4

Nervousness

1

2

3

4

Sleeping/eating changes

1

2

3

4

Avoiding situations

1

2

3

4

Dizziness/lightheadedness

1

2

3

4

Thanks for submitting!

I will be in contact with you within 48 hours.

AZ STRESS & ANXIETY RELIEF

sonia@azstresscoach.com

Home

Meet The AZ Stress Coach

Assess Your Stress

Stress & Your Body

Contact

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