Stress Impact Quiz

Your Stress Level Evaluation

The following questionnaire is a comprehensive look at your stress triggers within the past year. It will take less than 10 minutes to complete
Full Name

First NameLast Name
Gender

MaleFemale
Please enter your email here to receive your score:*
example@example.com
YOUR GENERAL HEALTH EVALUATION

As of today do the below situations and events impact your life or cause stress? Please select YES or NO.
Yes= This event or situation is a stress Trigger for me

No = This event or situation doesn't impact me.
Death of Spouse*

YesNo
Divorce*

YesNo
Marital Separation*

YesNo
Jail Term*

YesNo
Death of Close Family Member*

YesNo
Personal Injury Illness*

YesNo
Marriage*

YesNo
Fired at Work*

YesNo
Marital Reconciliation*

YesNo
Retirement*

YesNo
Change in Health of Family Member*

YesNo
Pregnancy*

YesNo
Sexual Difficulties*

YesNo
Gain of a New Family Member*

YesNo
Business Readjustment*

YesNo
Change in Financial State*

YesNo
Death of a Close Friend*

YesNo
Change in Responsibilities at Work*

YesNo
Change in Number of Arguments with Spouse*

YesNo
Foreclosure of Mortgage or Loan*

YesNo
Change in Responsibilities at Home*

YesNo
Child Leaving Home*

YesNo
Trouble with In-laws*

YesNo
Outstanding Personal Achievement*

YesNo
Spouse Begins or Stops Working*

YesNo
Begin or End School*

YesNo
Change in Living Conditions*

YesNo
Revision of Personal Habits*

YesNo
Trouble With Boss*

YesNo
Change in Work Hours or Conditions*

YesNo
Change in Residence*

YesNo
Change in Schools*

YesNo
Change in Recreation*

YesNo
Change in Church Activities*

YesNo
Change in Social Activities*

YesNo
Change in Sleep Habits*

YesNo
Change in Number of Family Get-Togethers*

YesNo
Change in Eating Habits*

YesNo
Taking a vacation*

YesNo
Celebrating Christmas*

YesNo
Minor Violation of the Law*

YesNo
Here's Your Total Impact of Stress To Your Life
Should be Empty:

Your Stress Level Evaluation

YOUR GENERAL HEALTH EVALUATION