Stress Questionnaire
A Warm Welcome.

Please fill in this quick questionnaire. It will help you gain clarity around the stress in your life and the area of focus if you would like to do the online program or are having a session. Please print the questionnaire so that you have a copy of it to refer to.

If you would like to contact me, please email Valee at valeemore2@gmail.com or text or call 021 123 8890 - New Zealand +64.

For your information, sessions can be carried out via www.zoom.us and are, therefore, available worldwide. Zoom is very easy to use and provides a better connection than Skype. Alternatively, sessions can be conducted by phone or in person by arrangement in Henderson.

If someone has referred you, please enter their name below.

My warmest wishes

Valee More

How did you hear about this questionnaire? *
Required
Self-Assessment
Please tick the stressful areas of life below that are relevant for you
Rating
Please rate those ticked above on a scale from 0 to 10, where 10 is extreme stress and 0 is no stress. Write down the first number that comes into your mind.
Please type those that are higher than 5/10 below
Your answer
For those that that are higher than 5/10, please tick the most occurring emotions that you experience when you are stressed.
Which area of life is the most important to work with first? In one or two sentences summarise the stress that you are experiencing. *
Your answer
If you are having a session or would like me to contact you, please leave your email address. Of course, it will be kept in the strictest confidence.
Your answer
Thank you for completing the questionnaire. If you are having a session, I look forward to meeting you and sharing these powerful tools that clears stress in minutes.
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