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