Stress

Stress is part of our lives. Stress can be sudden, short lived or prolonged. Different kinds of stress have different effects and complications. This questionnaire is designed to help you and your physician identify whether you are currently showing any signs of stress. If you feel that you are unduly stressed please remember to consult an appropriate health care professional.

Each question has several responses from which you are asked to choose the one that best describes your own situation. Please be sure that you select only one response per question.

Please ensure all information is completed correctly in order for us to respond to your assessment promptly.

Your Name (required):

Your Email (required):


Over the past six months:


QUESTION 01:
What is your marital status?

QUESTION 02:
Are you currently employed?

QUESTION 03:
How do you feel about your current stress levels?

QUESTION 04:
Do you have a history of stomach ulcers?

QUESTION 05:
Do you have a history of tension headaches?

QUESTION 06:
Do you suffer from stiff neck or muscle spasms?

QUESTION 07:
Do you have a history of heart attack or angina?

QUESTION 08:
Do you ever experience attacks of diarrhoea?

QUESTION 09:
How often are you physically active? (Do you exercise for more than 20 minutes?)

QUESTION 10:
Are you the main breadwinner of your family?

QUESTION 11:
Do you sometimes get pins and needles in your arms, hands, legs or feet?

QUESTION 12:
How often do you eat during the day?

QUESTION 13:
Are you ever late for appointments?

QUESTION 14:
How much time do you devote to a hobby or sport?

QUESTION 15:
Do you smoke?


Submit your self assessment form to the Mens Clinic International Doctor for evaluation: