Question 1 of 11

What is your first name? *

Question 2 of 11

What is your date of birth? *

Question 3 of 11

How intense is your stress right now? (1-10) *

Question 4 of 11

How long have you been experiencing this stress? *

A few days For a few weeks For several months For many years On and off for years

Question 5 of 11

Which physical symptoms of stress do you experience? *

Select all that apply

Headaches Muscle tension Digestive issues Skin problems Chronic fatigue Heart racing Difficulty breathing No particular affinity

Question 6 of 11

What are your main stressors? *

Select all that apply

Financial Relationship Work / Career Health Family Fear of the future Past trauma Isolation Global

Question 7 of 11

How are you currently coping with stress? *

Healthy coping (exercise) Healthy coping (creative outlet) Unhealthy coping (substances) Unhealthy coping (withdrawal) Mixed coping strategies No particular affinity

Question 8 of 11

Have you noticed a pattern in what triggers your stress? *

A specific person A specific environment A certain time of day Uncertain Constant Seasonal

Question 9 of 11

How much sense of control do you feel? (1-10) *

Question 10 of 11

How does your nervous system typically respond to stress? *

I confront it directly Flight (escape) I freeze Fawn (people-please to survive) Spiritual surrender

Question 11 of 11

Please describe the stress you are experiencing *

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