Stress Screening Test

To receive a free stress screening, please enter your information and complete the questionnaire below.
Rate your answers as follows:

  (1) Sometimes
(2) Often
(3) Never - or I don't know

1. Stress keeps me from sleeping soundly through the night.
1 2 3
2. I worry about how much stress I'm under.
1 2 3
3. I regularly work more than 40 hours a week at my job.
1 2 3
4. I recently started or stopped a habit (like dieting, smoking, etc).
1 2 3
5.  I was divorced or ended a long term relationship within the last year.
1 2 3
6. I moved in the last year.
1 2 3
7. I recently recieved a promotion or some other type of outstanding personal achievement.
1 2 3
8. I changed jobs in the last year.
1 2 3
9. In the past year, I experienced the death of a close family member, friend, or pet.
1 2 3
10. I recently experienced a personal injury or illness.
1 2 3
11. I feel tired during the day.
1 2 3
12.  Recently I've found it more difficult to control my emotions.
1 2 3
13. I always get a good night's sleep without worrying about work.
1 2 3
14.  I'm so busy I find it increasingly difficult to concentrate on the job in front of me.
1 2 3
15. I spend so long at work that my outside relationships are suffering.
1 2 3
16. If a project I am working on fails, I blame myself whether it was my fault or not.
1 2 3
17. If there's a disagreement about work, I defer to other people's judgement and abilities.
1 2 3
18. I have someone at work or outside it who I can confide in.
1 2 3
19. I accept that my work has and will change and welcome the opportunities this gives me.
1 2 3
20. I am not in control of the success or failure I make of my life.
1 2 3

Congratulations on completing this questionnaire. Enter your contact information below. I will contact you within the next day to discuss your results and the possibility of scheduling an appointment.

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Randi Fredricks, LMFT, CHT, RAS, CCN, CCH    ♦     1711 Hamilton Ave Suite A, San Jose, California, 95125     ♦     408-315-0645

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This site does not provide medical advice, diagnosis, or treatment and is intended for informational purposes only. No therapeutic relationship is established
by the use of this site. Randi Fredricks is a Psychotherapist and Licensed as a Marriage Family Therapist MFC 47803 and not licensed with the California
Medical Board or the Bureau of Naturopathic Medicine. © 2001-2010 Randi Fredricks. All rights reserved. Medical Disclaimer and Copyright