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Integrated Assessment
Individual Stress Assessment
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First Name
Your answer
How would rate your psychological health in terms of mental wellness? Do you feel stressed?
Worst
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10
Best
Clear selection
How would rate your physical health?
Worst
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9
10
Best
Clear selection
How would rate your energy levels? Do you feel motivated?
Worst
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9
10
Best
Clear selection
What was the most stressful day or moment of the week?
Your answer
How did you cope with your stressful event?
Your answer
Did your partner or spouse support you?
Yes
No
Maybe
Clear selection
Was there a breakdown in communication this week between each other?
Yes
No
Maybe
Clear selection
Do you believe and feel that your needs are being fulfilled by your partner? Why or why not?
Your answer
Do you feel and believe that you know the needs and desires of your partner or spouse? If so what do you believe that he or she knows what you need from them? (Immediate)
Your answer
Are you willing to acknowledge each other's needs and desires and commit to meeting those needs?
Yes
No
Maybe
Clear selection
Is there anything you will like to discuss during this time of counsel?
Your answer
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