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 StressI am grieving from a death of a family member (not spouse or child)I feel excluded by my familyI am grieving from the death of a childI experience everyday stress because of my relationship with an immediate family memberI have recently experienced a loss of friendshipI experience everyday stress because of my relationship with a member of my extended familyI am grieving from the death of a friendCaregiver StressI am the primary caregiver in my family with one or more childrenI am the caregiver of child, sibling, or parent with special needsI am responsible for caring for an aging family member or membersSocial StressI feel stressed by the number of social committments I haveI often feel lonely, alone, or isolatedFinancial StressI am anxious about my financial situationI am in conflict with a co-worker/business partner over financesI am in conflict with my spouse or family over our financial decisionsI am responsible for the primary income for my familyI can honestly say I live above my means, and I do not know what to do about itPhysical StressI need to replace my mattressMy walk/run unevenly wears the soles of my shoesMy footwear is not supportive for the demands I place on my feetI am carrying more weight than I wantI engage in physical exercise and wonder if I am using the proper formMy work station ergonomics are poorI use electronic devices for more than an hour per dayI am recovering from a surgery or surgeriesI engage in long distance endurance running, swimming, biking, etc.I do not have a regular stretch or movement routineMy work or hobbies require a lot of repetitive motionI regularly aid in lifting and transporting an aged family member or relativeI have recently been in a car accident (including "minor" fender benders)I have recently fallen or stumbled or slippedI regularly lift and transport young childrenI have chronic foot, ankle, knee, or hip degeneration or injury that changes the way I walk or runI do not have a regular exercise programI am still experiencing symptoms from a mild traumatic brain injuryI am still experiencing symptoms from a neck injury/whiplashMy sleep quality is poor because I cannot fall asleep or stay asleepChemical StressI am on two or more regular medicationsI do not currently use air filtration or air purification in my homeI eat more sugar than I probably shouldI have hobbies that increase my exposure to chemicalsI regularly use recreational drugsI am addicted to nicotineI do not currently use water purification in my homeI rely on over the counter pain relieversI am addicted to caffeineI know I have nutritional deficienciesI have tested positive for a gene mutation that reduces my natural detoxification abilityI drink more than I probably shouldI live near a high traffic area (freeway or main thoroughfare)I have seasonal allergiesI am currently withdrawing from caffeineI am exposed to industrial strength chemicals in my workplaceI have food allergiesI am exposed to industrial stength chemicals in my homeI am currently withdrawing from nicotineI am currently overcoming an addiction to recreational drugsCareer StressThere is little opportunity for advancement in my current positionI am not adequately paid for my positionMy work environment is physically or emotionally drainingI am in conflict with my co-workersI feel like I could be fired at any minuteI do not get enough vacation timeI am asked to cover shortcoming of other workers, or short-staffing situationsMy work is not very satisfyingI am in conflict with my bossI spend too much time at workLife Transition StressI am getting marriedI am getting divorcedI am having a babyI am moving/recently moved away from family and close friendsI am grieving the death of my spouseI am in the process of purchasing or selling a homeI am moving or expanding a businessEmail* 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 CommentsThis field is for validation purposes and should be left unchanged.