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Health-Resiliency-Stress Questionnaire (HRSQ)
Copyright, all rights reserved (3/2019)

Your answers are also important to better understand how stress and resiliency affect health.

Filling out this questionnaire may give you and your provider helpful information about your health and wellness. This form usually takes about 3 - 5 minutes to complete, but don't worry if you need some extra time. Your participation is very important to your health care provider.

If at any point you do not want to complete this questionnaire, simply exit-out and your answers will not be recorded. If you do complete this form, your information will automatically be sent to your health care provider's email. (You will be asked for that in a question below.) Your answers will be recorded in a large database. No information will be recorded about who you are or that can identify you.

Please fill this out as completely and as best as you can. Thank you for participating!

Your doctor's or therapist's email address *
Your answer
Code from your doctor or therapist *
Your answer
Age *
Gender *
Zip Code (enter 00000 if you do not have a permanent address) *
Your answer
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