Self Report Survey
Fill in option for each item that best applies to you and submit your email at the end of the survey for feedback.
Fill in option for each item that best
applies to you and
submit your
email
for feedback.
1
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Self Report Survey
Stress Inventory
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Client Satisfaction
Insurances Accepted
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wake up angry
Rarely - 0pts
Sometimes -1pts
Often - 2pts I feel like a loser
Rarely - 0pts
Sometimes -1pts
Often - 2pts I show my anger with aggressive acts
Rarely - 0pts
Sometimes -1pts
Often - 2pts People say I don't listen
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wish I could manage my worries better
Rarely - 0pts
Sometimes -1pts
Often - 2pts I plan to get people back
Rarely - 0pts
Sometimes -1pts
Often - 2pts People say I'm an angry person
Rarely - 0pts
Sometimes -1pts
Often - 2pts People say I'm careless
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wake up nervous
Rarely - 0pts
Sometimes -1pts
Often- 2pts I feel like I can't concentrate b/c I'm worried
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wish I could manage my anger better
Rarely - 0pts
Sometimes -1pts
Often - 2pts I worry
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wish I could pay attention better
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wake up feeling sad or down
Rarely - 0pts
Sometimes -1pts
Often - 2pts When I feel down I hurt someone or myself
Rarely - 0pts
Sometimes -1pts
Often - 2pts I feel drained
Rarely - 0pts
Sometimes -1pts
Often - 2pts I do what others tell me to do
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wish I could control what I do better
Rarely - 0pts
Sometimes -1pts
Often - 2pts I find it hard to wait my turn
Rarely - 0pts
Sometimes -1pts
Often - 2pts I feel tense
Rarely - 0pts
Sometimes -1pts
Often - 2pts I wish I could manage my sad feelings better
Rarely - 0pts
Sometimes -1pts
Often - 2pts My actions are caused by what others do
Rarely - 0pts
Sometimes -1pts
Often - 2pts I have a hard time making decisions
Rarely - 0pts
Sometimes -1pts
Often - 2pts People say I rush
Rarely - 0pts
Sometimes -1pts
Often-2pts I believe what I do now will not change tomorrow