Simple Stress Solutions - Registration form
INTRODUCTION

This is your first step to gain clarity about what causes your overwhelm. Your responses will help me tailor your session for your needs. The answers you give will be treated in the strictest confidence. If you are uncertain about anything, put in a ‘?’.

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Email *
Your name *
Your email address *
Occupation and activities / duties in the last 3 years
Current stress level
What causes you stress – choose and rank the top 3 challenges
First
Second
Third
Being under pressure at work
Worrying about something
Not in control
Major life changes
Health issues
Relationship issues
Responsibilities
Financial difficulties
Uncertainty
Not having enough activities in your life
Other
Clear selection
Please mark what physical / emotional / mental symptoms you’ve experienced in the past 3 months *
Required
What would you like to get out of this session?
How would you like to feel after the consultation?  
Is there anything you would like to add about your health of lifestyle? Please write below:
Submit
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