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Emotional Support Assessment.
Be as honest as you can with yourself and you complete this survey otherwise the process is futile
,
your responses will remain confidential, and it ill assist us to know what level of support you need.
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* Indicates required question
Email
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Your email
Full Name.
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Your answer
Current Age.
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Your answer
Gender
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Your answer
Mobile No.
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Your answer
I often feel overwhelmed by personal responsibilities.
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Strongly Disagree
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2
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5
Strongly Agree
I have difficulty finding time for relaxation and self-care.
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Strongly Disagree
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5
Strongly Agree
My personal relationships (e.g., family, friends) contribute to my stress.
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Strongly Disagree
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2
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5
Strongly Agree
Financial concerns significantly impact my stress levels.
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Strongly Disagree
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2
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5
Strongly Agree
Health issues or concerns are a major source of stress for me.
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Strongly Disagree
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Strongly Agree
I have recently experienced significant life changes (e.g., marriage, divorce, relocation) that have caused stress.
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Strongly Disagree
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2
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5
Strongly Agree
I experience high levels of stress at my workplace.
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Strongly Disagree
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5
Strongly Agree
Deadlines and workload often lead to stress in my job.
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Strongly Disagree
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5
Strongly Agree
I feel unsupported or undervalued by my colleagues or superiors.
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Strongly Disagree
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2
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4
5
Strongly Agree
Work-related conflicts or difficulties affect my stress levels.
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Strongly Disagree
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2
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5
Strongly Agree
I find it challenging to maintain a healthy work-life balance.
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Strongly Disagree
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5
Strongly Agree
I frequently experience headaches, muscle tension, or body aches.
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Strongly Disagree
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5
Strongly Agree
I have trouble sleeping or experience insomnia due to stress.
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Strongly Disagree
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2
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5
Strongly Agree
Digestive problems (e.g., upset stomach) are common when I'm stressed.
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Strongly Disagree
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2
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5
Strongly Agree
My energy levels are consistently low due to stress.
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Strongly Disagree
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5
Strongly Agree
I notice changes in my appetite, either overeating or loss of appetite when stressed.
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Strongly Disagree
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2
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5
Strongly Agree
I often feel anxious or nervous.
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Strongly Disagree
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2
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4
5
Strongly Agree
Stress leads to frequent mood swings or irritability.
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Strongly Disagree
1
2
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5
Strongly Agree
I find it challenging to relax or calm my mind.
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Strongly Disagree
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2
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4
5
Strongly Agree
I experience moments of sadness or depression due to stress.
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Strongly Disagree
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2
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5
Strongly Agree
I have recently experienced significant losses (e.g., bereavement, loss of a job) that have caused stress.
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Strongly Disagree
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5
Strongly Agree
I have received a serious medical diagnosis or have a family member with a serious medical condition causing stress.
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Strongly Disagree
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5
Strongly Agree
Pause for a moment and acknowledge the positive stride you've made in self-awareness. Feel free to provide any additional information you wish to share regarding your emotional support needs.
*
Your answer
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