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Home
Booking
Treatments
What do we Offer?
Sports Medicine
Sports Science
Physiotherapy
Health, lifestyle & nutrition
Career
Blog
Contact
About
FAQ
Meet The Team
Success Stories
Questionniare
Telephone Consultations Form
Perceived Stress Questionnaire
Initial Subjective Assessment
Medical Questionnaire and Subjective Assessment Forms
Medical Questionnaire
Patient Social Questionnaire
Event Medical
Please fill out the following form so that we can assess your Stress.
Name
*
First Name
Last Name
Mobile Phone Number
*
Email Address
*
0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Fairly Often, 4 = Very Often
1. In the last month, how often have you been upset because of something that happened unexpectedly?
*
0
1
2
3
4
2. In the last month, how often have you felt that you were unable to control the important things in your life?
*
0
1
2
3
4
3. In the last month, how often have you felt nervous and stressed?
*
0
1
2
3
4
4. In the last month, how often have you felt confident about your ability to handle your personal problems?
*
0
1
2
3
4
5. In the last month, how often have you felt that things were going your way?
*
0
1
2
3
4
6. In the last month, how often have you found that you could not cope with all the things that you had to do?
*
0
1
2
3
4
7. In the last month, how often have you been able to control irritations in your life?
*
0
1
2
3
4
8. In the last month, how often have you felt that you were on top of things?
*
0
1
2
3
4
9. In the last month, how often have you been angered because of things that happened that were outside of your control?
*
0
1
2
3
4
10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?
*
0
1
2
3
4
Thank you for submitting your Perceived Stress Scale Questionnaire!