Dr Leigh Martens

Self-Assessments

Please answer every question.

Over the past two weeks or more, how often have you experienced or been concerned about any of the following?

Question	Almost Never	Sometimes	Often	Very Often
1: Feeling unusually stressed, anxious or worried?
2: Found it difficult to suppress or control your apprehensions, concerns or anxiety levels?
3: Felt more irritable, agitated or impatient than usual?
4: Became tired, more easily fatigued or felt noticeably burnt out?
5: Had difficulty with your ability to concentrate or felt your mind going blank under pressure?
6: Experienced spasm or pain in your neck, shoulders or back muscles?
7: Developed heartburn, bloating or cramp-like abdominal pain?
8: Had trouble falling or staying asleep, or experienced restless, unsatisfying sleep?
9: Thought that your stress levels had a negative impact on your functioning at home or work?