The Stress and Fatigue Profile

Please score the following according to your experience over the last 90 days

0 = never :: 1 = occasionally :: 2 = frequently :: 3 = always

Your Details

Name

Email

Web site

Mental Stress Profile

1) poor concentration / memory

0	1	2	3

2) indecision

0	1	2	3

3) mental sluggishness

0	1	2	3

4) depression

0	1	2	3

5) 'foggy' brain

0	1	2	3

6) thinking confused under pressure

0	1	2	3

7) disillusioned, apathy

0	1	2	3

8) reduced initiative

0	1	2	3

9) mental overload

0	1	2	3

10) irritable, impatient

0	1	2	3

11) procrastination

0	1	2	3

12) irrational thinking

0	1	2	3

13) dismissive

0	1	2	3

14) tense, nervous - can't relax

0	1	2	3

15) overly emotional

0	1	2	3

16) frustration, anger

0	1	2	3

17) apprehensive, fearful

0	1	2	3

18) feelings of inadequacy

0	1	2	3

Adrenal Stress Profile

19) easily fatigued

0	1	2	3

20) force myself to keep going

0	1	2	3

21) afternoon low between 2pm and 4pm

0	1	2	3

22) tired between 9pm - 10pm but resist going to bed

0	1	2	3

23) do my best work late at night

0	1	2	3

24) second burst of energy around 11pm and stay up late

0	1	2	3

25) dizziness on standing up

0	1	2	3

26) feel weak and shaky

0	1	2	3

27) eyes sensitive to bright light

0	1	2	3

28) sex drive reduced / lacking

0	1	2	3

29) cravings - salt, sugar, tobacco, alcohol or drugs

0	1	2	3

30) weakness after colds / flu

0	1	2	3

31) frequent bouts of recurring illness

0	1	2	3

32) frequent infections

0	1	2	3

33) tiredness not relieved by sleep

0	1	2	3

34) heavy stress causes complete exhaustion

0	1	2	3

35) feel confused / paralyzed under stress

0	1	2	3

36) chronic fatigue

0	1	2	3

Thyroid Stress Profile

37) experience chronic fatigue

0	1	2	3

38) sensitive to cold weather

0	1	2	3

39) frequently depressed

0	1	2	3

40) swollen eyes or face

0	1	2	3

41) chronic constipation

0	1	2	3

42) dry, flaky skin

0	1	2	3

43) easily irritated

0	1	2	3

44) slowed or slurred speech

0	1	2	3

45) excessive hair loss

0	1	2	3

46) morning headaches

0	1	2	3

47) women : heavy menstrual flow

0	1	2	3

48) women : suffer from PMS

0	1	2	3

49) low sex drive

0	1	2	3

50) difficulty concentrating or remembering

0	1	2	3

51) cry easily

0	1	2	3

52) difficulty sleeping

0	1	2	3

53) cold hands and feet

0	1	2	3

54) gain weight easily

0	1	2	3

Blood Sugar Stress Profile

55) need stimulants to keep going eg coffee, cola

0	1	2	3

56) lightheaded if meals delayed

0	1	2	3

57) inward trembling

0	1	2	3

58) frequently skip meals

0	1	2	3

59) poor, inadequate diet

0	1	2	3

60) skipping meals causes tiredness, irritability

0	1	2	3

61) often become hungry when under stress

0	1	2	3

62) hungry in between meals

0	1	2	3

63) unusual hunger

0	1	2	3

64) sugar cravings

0	1	2	3

65) wake up at night feeling hungry

0	1	2	3

66) morbid fears and / or anxieties

0	1	2	3

67) feel weak, shaky and jittery

0	1	2	3

68) addicted to sweets, alcohol, cigarettes, drugs

0	1	2	3

69) binge eating

0	1	2	3

70) feel spacey or detached

0	1	2	3

71) severe mood swings

0	1	2	3

72) poor sleeping patterns

0	1	2	3

Digestive Stress Profile

73) abdomen bloats after eating

0	1	2	3

74) indigestion 1 - 3 hours after eating

0	1	2	3

75) heartburn

0	1	2	3

76) indigestion worse due to worry, stress

0	1	2	3

77) irritable bowel

0	1	2	3

78) poor dietary habits

0	1	2	3

79) excessive wind, flatulence

0	1	2	3

80) constipation

0	1	2	3

81) alternating bowel habits constipation / diarrhoea

0	1	2	3

82) regularly use antacids

0	1	2	3

83) increased incidence of food allergies

0	1	2	3

84) tiredness after eating

0	1	2	3

85) fatty foods cause nausea and distress

0	1	2	3

86) abdominal pain, cramps

0	1	2	3

87) irregular eating patterns

0	1	2	3

88) pain on right abdomen below rib cage

0	1	2	3

89) mucous or undigested food in stools

0	1	2	3

90) more than 3 bowel movements daily

0	1	2	3

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