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