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 experience everyday stress because of my relationship with a member of my extended family I am grieving from a death of a family member (not spouse or child) I am grieving from the death of a friend I am grieving from the death of a child I feel excluded by my family I have recently experienced a loss of friendship I experience everyday stress because of my relationship with an immediate family member Caregiver Stress I am the primary caregiver in my family with one or more children I am responsible for caring for an aging family member or members 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 conflict with a co-worker/business partner over finances I am anxious about my financial situation I can honestly say I live above my means, and I do not know what to do about it I am responsible for the primary income for my family I am in conflict with my spouse or family over our financial decisions Physical Stress I use electronic devices for more than an hour per day My work station ergonomics are poor I am carrying more weight than I want I regularly lift and transport young children My sleep quality is poor because I cannot fall asleep or stay asleep I regularly aid in lifting and transporting an aged family member or relative I need to replace my mattress I have chronic foot, ankle, knee, or hip degeneration or injury that changes the way I walk or run 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) My footwear is not supportive for the demands I place on my feet I am still experiencing symptoms from a neck injury/whiplash I am still experiencing symptoms from a mild traumatic brain injury My work or hobbies require a lot of repetitive motion I have recently fallen or stumbled or slipped I do not have a regular stretch or movement routine I engage in long distance endurance running, swimming, biking, etc. I do not have a regular exercise program I am recovering from a surgery or surgeries My walk/run unevenly wears the soles of my shoes Chemical Stress I rely on over the counter pain relievers I eat more sugar than I probably should I drink more than I probably should I have tested positive for a gene mutation that reduces my natural detoxification ability I have hobbies that increase my exposure to chemicals I am addicted to caffeine I know I have nutritional deficiencies I regularly use recreational drugs I have food allergies I have seasonal allergies I do not currently use air filtration or air purification in my home I am currently withdrawing from caffeine I am exposed to industrial stength chemicals in my home I am currently withdrawing from nicotine I live near a high traffic area (freeway or main thoroughfare) I am currently overcoming an addiction to recreational drugs I am exposed to industrial strength chemicals in my workplace I do not currently use water purification in my home I am addicted to nicotine I am on two or more regular medications Career Stress There is little opportunity for advancement in my current position I am in conflict with my co-workers I do not get enough vacation time I spend too much time at work I am asked to cover shortcoming of other workers, or short-staffing situations My work is not very satisfying I am not adequately paid for my position I am in conflict with my boss My work environment is physically or emotionally draining I feel like I could be fired at any minute Life Transition Stress I am grieving the death of my spouse I am getting married I am moving/recently moved away from family and close friends I am in the process of purchasing or selling a home I am having a baby I am getting divorced 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 NameThis field is for validation purposes and should be left unchanged.