Stress Test Questionnaire

The results of a stress test questionnaire helps in determining the level of stress a person has, the various things causing stress, and how the stress is hampering their day-to-day life. This information helps doctors and psychiatrists in determining what solutions can be offered to a person suffering from stress and also helps in implementing sound stress management techniques.

Stress Test Questionnaire Sample

Name of the individual: ________________________________

Age: ______ Sex: _______  Occupation: ______________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Email: _________________________

Q1. Which of the following stress related conditions have you been diagnosed with?

a)   Acute stress

b)   Episodic acute stress

c)   Chronic stress

d)   None

Q2. Do you have difficulty sleeping?

a)   Yes

b)   No

Q3. What do you do when you feel stressed?

a)   Eat a lot

b)   Sleep a lot

c)   Use various methods to take away stress like cooking, gardening etc

d)   Lose your anger over others

e)   Others (pls specify): __________________________

Q4. Which of the following is the primary cause of stress?

a)   Office environment

b)   Work responsibility

c)   Personal life

d)   Relationship with spouse

e)   Relationship with family

f)    General

Q5. How do you spend your leisure time?

a)   Working

b)   With family

c)   Picnic

d)   Outdoor adventure

e)   Don’t know

Q6. When you are stuck in traffic, what do you do?

a)   Think about work

b)   Reflect about past experiences

c)   Show your frustration by honking and shouting

d)   Listen to music or relax

Q7. How well are you able to manage work and family?

a)   Very well

b)   Well enough

c)   Not well enough

d)   Bad

e)   Not able to manage at all

Q8. Do you feel emotionally tired and drained throughout the day?

a)   Always

b)   Sometimes

c)   Rarely

Category: Stress Questionnaire

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