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Better Health Chiropractic

   
 

Dr. Jeffery G. Beavers, DC

 

 

Stress Questionaire

First Name:
Last Name:
Age:
Address:
City:
State:
Zip:
Phone:
Fax:
Email Address:

Do you suffer from stress or burnout? Below are 13 signs that you may be overstressed. Answer Honestly!
   

Yes
Sometimes
No
1
Do you feel tired all the time?
2
Do you always feel 'run down'?
3
Do you get annoyed and angry at things you really should be fine with?
4
Are you hard on others and yourself?
5
Do you find yourself angry alot during the week?
6
Do you yell at people more than usual?
7
Are you more negative about yourself and life lately?
8
Do you feel like the walls are caving in?
9
Do you say hurtfull things to the ones you love?
10
Do you have trouble falling asleep because your mind won't stop thinking?
11
Do you have dreams that you are running and not getting anywhere?
12
Are you eating more than usual in response to the stress in your life?
13
Does your chest ever hurt or do you have trouble breathing during the course of your work day?

Would you like to hear the results of your assessment and the recommendations of care via the telephone or email?
Telephone Email


 
   
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