Disturbance to physical or mental equilibrium leads to stress and different people feel stressed for different reasons and some of them use numerous techniques to get rid of stress. This questionnaire on stress assembled few questions on stress to know the reasons behind stress from different individuals.




Fill your details:

Name: ________________
Gender: _______________
How old are you:  ________________
Profession: _______________
Income: ______________
Area/ district you live: ______________

Stress Disorder Questionnaire Sample:


1. How often you feel stressed?
Specify your answer: _______________________

2. Why you are feeling stressed?

Over work
Studies
Family problems
Personal issues
Health problems
Any other________________

3. Mention your day plan?
Specify your answer: _______________________

4. How many hours a day you sleep?
a)Below 8 hours b) 8 hours c) above 8 hours

5.How many hours a day you work?
a)Below 8 hours b) 8 hours c) above 8 hours

6.Do you have any mental tensions?
a)Yes b) no c) some times

7.When your stressed what all activities you do?

Singing/ listening music
Taking medicine
Sleeping
Meditation/exercise
Any other __________________

8. How will you reduced your stress?

Consult doctor
Medication
Any other_________________

9. Are you using any medicines to get rift of stress?
a)Yes b) no c) some times

10. Do you have a habit of doing meditation, yoga, exercise or any other habit?
a) Yes b) no c) some times

11.Mention your diet plan?
Specify your answer: __________________

12. When you are stressed how will you react?
a)Anger b) normal c) any other answer: _______________

13. Do you have a habit of roaming in hot sun and pollution?
a)Yes b) no c) some times

14. From Which stress you are suffering more?
A) Mental stress B) physical stress

15. List out the tension/ problems you have?
Specify your answer: ___________________

16. Which among following type you are?
A) Sensitive B) emotional c) kind d) hard hearted

17. When you are stressed are you getting headache?
a) Yes b) no c) some times

18. When you are stressed are you getting any body pains?
a)Yes b) no c) some times

19. What all health problem you have?
Please mention........................

20. Did you find the reason behind your stress?
a)Yes b) no c) some times

21. Did you ever visit stress management centers to get rid of stress?
a)Yes b) no