Have difficulties staying awake during the day
Health and Wellness Survey
Wake up unexpectedly during the night
Get the amount of sleep you needed
All of the time
Most of the time
Some of the time
None of the time
Have trouble falling asleep at night
Play sports
How often during the past 2 weeks did you:
Listen to music
Take a walk/hike
This survey is meant as a guide to be part of an assessment process. Please answer the following questions as open and honest as possible.
I am able to pinpoint situations that cause me stress.
Always True
Frequently True
Seldom True
Never True
In general, would you say your health is:
Excellent
Very Good
Good
Fair
Poor
Read a book
Please indicate the activities in which you participate that help you relieve stress.
I avoid eating foods that are high in calories and fat.
Exercise
Yes
No
Eat Right
Deep breathing