Initial Assessment

Please take a few moments to answer these questions to the best of your ability prior to using CD

Answer each question according to the following scale:

1)     Never/ very rarely

2)     Rarely

3)     Occasionally

4)     Usually

5)     Always

About Your Stress

I feel relaxed                                       1      2      3      4      5

I sleep well at night                            1      2      3      4      5

I choose nutritious foods                     1      2      3      4      5

I am able to focus                                1      2      3      4      5

I am energetic                                      1      2      3      4      5

I am pain free                                      1      2      3      4      5

I have a feeling of well being              1      2      3      4      5

Personal Information (optional)

Age:                             18-30      31-50      51–70      70 +

Exercise per/week:      1-2      3-4      5-7

Gender:                       M / F

Occupation:

Thank you for taking the time to complete our questionnaire