Stress Test

HealoMax Stress Assessment

Name:

Email:

Gender:
Male Female Other
Profession:

Age:

Location:

Country:

Please answer the following questions on a scale of 1-5:

1. Do you feel: Overwhelmed/ Less Enjoyment or Energy/ Frequent Cold or Pains? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

2. Increased forgetfulness or confusion or disorientation / poor decision making? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

3. Depending on drugs or excessive use of alcohol or caffeine or smoking? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

4. Procrastination or avoidance / decreased self-esteem or self-care? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

5. Do you feel: Irritable or Angry / Less Compassionate to others? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

6. Do you feel lonely or isolated or helpless or hopeless? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

7. Decreased concentration or repeated mistakes? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

8. Are you constantly worried or restless? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

9. Any changes in your sleep pattern? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often

10. Eating excessively or insufficiently? 1. Never 2. Rarely 3. Sometimes 4. Often 5. Very Often





INSTRUCTIONS:

Answer all the questions as soon as possible by selecting one option from 1 to 5.
More time spent on questions may affect your assessment result.
Click the “Submit” button to complete the stress assessment.
See the results of your stress assessment on the screen with recommendations and stress level.

Stress levels are categorized into three:
Low, Moderate, and High.