1. |
How are your energy levels? |
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Low |
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Moderate |
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High |
|
 |
2. |
Do you have trouble falling asleep or staying asleep? |
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Sometimes |
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Frequently |
|
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Rarely |
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3. |
How would you rate your level of confidence? |
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Low |
|
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Moderate |
|
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High |
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4. |
How often do you suffer minor ailments? |
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Frequently |
|
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Occasionally |
|
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Rarely |
|
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5. |
How often do you feel irritable? |
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Rarely |
|
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All the time |
|
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Sometimes |
|
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6. |
How do you cope with change? |
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Defensively |
|
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I look for the advantages |
|
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I find a way through |
|
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7. |
Do you have feelings of fear or panic? |
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Often |
|
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Rarely |
|
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Sometimes |
|
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8. |
Do you feel worried? |
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Rarely |
|
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Sometimes |
|
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Often |
|
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9. |
How well do you cope with conflict? |
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I seek win-win solutions |
|
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I roll with the punches |
|
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I avoid it at all costs |
|
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10. |
Do you feel emotional or cry easily? |
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Rarely |
|
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Sometimes |
|
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Frequently |
|
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11. |
Do you get neck, shoulder or back pain? |
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Frequently |
|
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Sometimes |
|
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Rarely or never |
|
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12. |
Do you feel apathetic, as if nothing matters? |
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Frequently |
|
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Rarely or never |
|
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Sometimes |
|
|
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|
|
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 |
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