Stress Hormone Questionnaire
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Email *
Today's Date *
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First Name *
Last Name *
1) I feel stressed or unsafe around coworkers.
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2) I feel stressed or unsafe around my friends.
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3) I feel stressed or unsafe around my family.
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4) I feel stressed or unsafe around my parents.
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5) I feel stressed or unsafe around people in my home.
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6) I feel stressed or unsafe around people at school.
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7) I worry about getting pulled over while driving.
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8) I worry about an IRS audit.
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9) I worry about my debt.
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10) I worry about my retirement.
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11) I worry about my monthly budget.
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12) I crave sugar or refined carbs like breads and pastas.
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13) I can’t or don’t like to get by without caffeine, tobacco, alcohol, or marijuana.
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14) I have difficulties with sleeping.
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15) I have an excessive or inconsistent appetite.
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16) I am irritable, on edge, or have exaggerated emotions.
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17) I worry about the future.
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18) I worry about the past.
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19) I have headaches, fatigue, or chronic pain.
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20) I have an excessive or low sex drive.
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21) I do emotional eating or binge eating after unexpected or emotional events.
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22) I sweat excessively when not exercising.
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23) I have indigestion, acid reflux, irregular bowel movements, or other digestive issues.
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24) I have anxiety or depression.
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25) I get less than 7.5 hours of sleep each night.
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26) I lack social support from friends and family.
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27) I regularly perform high intensity exercise.
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28) I am a couch potato.
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29) I never go barefoot.
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30) I am easily inflicted with motion sickness.
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31) I am overweight or underweight.
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32) I come down with colds or flus more than once per year.
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33) I am upset by trivial things.
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34) I am often impatient.
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35) I tend to be easily bored.
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36) It is hard to relax especially at the end of the day.
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37) I have a hard time coping with mistakes or the thought of making mistakes.
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38) I never seem to be able to get ahead in life.
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39) I never have enough time or often feel rushed.
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40) My thoughts tend to be repetitive or obsessive.
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41) I am stressed about my never ending “To-do” list.
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