Stress Test Daily Stress Checklist How are your mind and body affected by the common sources of stress? Please take your time to consider each item on this checklist, and mark those items that you currently experience. Relationship Stress I am grieving from a death of a family member (not spouse or child) I feel excluded by my family I have recently experienced a loss of friendship I am grieving from the death of a friend I experience everyday stress because of my relationship with an immediate family member I experience everyday stress because of my relationship with a member of my extended family I am grieving from the death of a child Caregiver Stress I am responsible for caring for an aging family member or members I am the primary caregiver in my family with one or more children I am the caregiver of child, sibling, or parent with special needs Social Stress I often feel lonely, alone, or isolated I feel stressed by the number of social committments I have Financial Stress I am in a conflict with a co-worker/business partner over finances I am anxious about my financial situation I am in conflict with my spouse or family over our financial decisions I am responsible for the primary income for my family I can honestly say I live above my means, and I do not know what to do about it Physical Stress My footwear is not supportive for the demands I place on my feet My walk/run unevenly wears the soles of my shoes I have chronic foot, ankle, knee, or hip degeneration or injury that changes the way I walk or run I do not have a regular stretch or movement routine I am carrying more weight than I want I am still experiencing symptoms from a mild traumatic brain injury My work station ergonomics are poor My sleep quality is poor because I cannot fall asleep or stay asleep I need to replace my mattress I do not have a regular exercise program My work or hobbies require a lot of repetitive motion I engage in physical exercise and wonder if I am using the proper form I have recently been in a car accident (including "minor" fender benders) I regularly aid in lifting and transporting an aged family member or relative I engage in long distance endurance running, swimming, biking, etc. I am still experiencing symptoms from a neck injury/whiplash I am recovering from a surgery or surgeries I have recently fallen or stumbled or slipped I use electronic devices for more than an hour per day I regularly lift and transport young children Chemical Stress I have tested positive for a gene mutation that reduces my natural detoxification ability I am currently withdrawing from nicotine I am addicted to caffeine I am exposed to industrial strength chemicals in my workplace I have food allergies I have seasonal allergies I am addicted to nicotine I drink more than I probably should I regularly use recreational drugs I have hobbies that increase my exposure to chemicals I am on two or more regular medications I am exposed to industrial stength chemicals in my home I know I have nutritional deficiencies I am currently overcoming an addiction to recreational drugs I do not currently use water purification in my home I rely on over the counter pain relievers I eat more sugar than I probably should I am currently withdrawing from caffeine I live near a high traffic area (freeway or main thoroughfare) I do not currently use air filtration or air purification in my home Career Stress There is little opportunity for advancement in my current position I spend too much time at work I am in conflict with my co-workers I am in conflict with my boss I am asked to cover shortcoming of other workers, or short-staffing situations I do not get enough vacation time I am not adequately paid for my position My work environment is physically or emotionally draining I feel like I could be fired at any minute My work is not very satisfying Life Transition Stress I am getting divorced I am having a baby I am moving/recently moved away from family and close friends I am grieving the death of my spouse I am getting married I am in the process of purchasing or selling a home I am moving or expanding a business Email* Enter Email Confirm Email Please enter your email to receive a copy of your information, and your score. Keep in mind that most email is not HIPAA safe. All information provided via this web form is confidential, and your email will not be shared or sold or distributed in any way. Name* First EmailThis field is for validation purposes and should be left unchanged.