Stress Survey:

What Are Your Stress Concerns?

What are your most stressful moments? When you get stressed, how does it affect you?

Each of us has a different way we vulnerable to stress. I have terrible mood swings. Someone else may get headaches. Her sister may suffer stomach upset.

I'm always looking to update my website and bring you more valuable information. Knowing where stress affects you the most is very helpful in that process.

Thank you for taking my stress survey.

Please note that all fields followed by an asterisk must be filled in.

First Name*

First Name*

E-mail Address

What is the greatest source of your stress?

	Mothering Responsibilities
	Partner/Spouse
	Your Parents
	Work
	Finances
	Health
	Moving
	Relationship Change (Marriage/Divorce)
	Other

If you said "other", what is the greatest source of your stress?

What is affected the most when you are stressed?

	Your Mothering
	Your Ability to be a Good Wife/Partner
	Your Ablity to Work
	Your Health
	Your Mood
	Other

If you said "other", what is affected the most?

What symptoms of stress do you experience the most?

	Sleep Problems
	Digestion
	Anxiety
	Mood Swings
	Rashes/Skin Problems
	Lack of Mental Focus
	Exhaustion
	Depression
	Lack of Sex Drive
	Other

If you said "other", what is your worst stress symptom?

What would help you with your stress the most?

	Organization/Time Management
	Learning to Say No
	Relaxation Tips
	Time Off
	Parenting Tips
	Health/Nutrition Help
	Financial Tips
	Exercise Plan
	Spiritual Connection
	Other