2.
Hours of sleep each night:
3.
Hours of exercise per week:
4.
Alcoholic drinks per week:
5.
Meals eaten out per week:
6.
Do you have any downtime or participate in quiet mindfulness activities?
ie: Pilates, yoga, meditation, quiet walks, personal hobbies.Deselect Answer
7.
Over the past 30 days, how stressful would you say your life is?
8.
Over the past 30 days, has stress negatively affected your daily tasks?
9.
Over the past 30 days, I have had a high intake of sugar and/or processed foods.
10.
Over the past 30 days, I have been feeling worn down and/or burnt out
11.
Over the past 30 days, I have needed caffeine or energy drinks in the morning or afternoon to give me energy.
12.
Over the past 30 days, I seem to have lower than usual energy.
13.
Over the past 30 days, I have experienced body aches and pains.
14.
Over the past 30 days, I have had periods of low moods.
15.
Over the past 30 days, I have felt more irritable.
16.
Over the past 30 days, my weight and metabolism have changed.
17.
Over the past 30 days, I can't seem to focus or concentrate.
18.
Over the past 30 days, I have had anxious feelings.
19.
Over the past 30 days, I have felt totally exhausted most of the day and only have a few productive hours.
20.
Over the past 30 days, I have found myself pushing through fatigue to get things done.
21.
Over the past 30 days, I have been sleeping a lot but never feel rested.
22.
Over the past 30 days, I have had difficulty getting to sleep and/or wake up in the middle of the night.
23.
Over the past 30 days, I have experienced strong craving for sweet or salty foods.
24.
Over the past 30 days, I have felt overwhelmed by daily tasks and all that is on my plate.
25.
Over the past 30 days, I have had a low sex drive.
26.
Over the past 30 days, I have been unable to enjoy socializing with family and/or friends
