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1. How frequently do you moderately exercise?
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2. How often do you get a full, restful night of sleep?
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3. To what extent is your energy sufficient for our work and daily activities?
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4. How closely does your weight approach the ideal level?
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5. To what extent do you eat a nutritious diet?
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6. Which of the following best describes your use of tobacco?
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7. Which of the following best describes your use of alcohol?
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8. To what extent do you believe that you have a history of coping well with highly stressful situations?
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9. How confident are you of being able to control your emotions in stressful situations?
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Please select a number
10. When things are not going well, how likely are you to view the situation as being temporary rather than permanent?
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Please select a number
11. When something bad happens to you, how likely are you to exaggerate its importance?
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Please select a number
12. When stressed by a complex situation, how likely are you to focus your attention on those aspects of the situation that you can manage?
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13. When highly stressed, how capable are you of changing your thinking to calm down?
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Please select a number
14. When confronted with a stressful situation, how likely are you to wait passively for events to develop rather than to take charge?
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Please select a number
15. Which of the following courses of action are you most likely to take when you have become thoroughly frustrated?
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16. If you had worn an article of clothing one day and then found it to be flawed, how likely would you be to return it and ask for a refund?
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Please select a number
17. When an unexpected, negative event happens to you, how likely are you to actively seek information about the event and how to cope with it?
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18. How much decision-making power so you have in your family?
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Please select a number
19. How much decision-making power do you have in your working environment? (if not working outside the home at present, use your last job as a basis for answering this question.)
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Please select a number
20. To what extent do you believe that events in your life are merely the result of luck, fate, or chance?
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Please select a number
21. What is your best guess as to the extent and quality of contact you had with your parent(s) shortly after birth?
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22. During your early childhood, to what extent was your mother both calm and generally permissive?
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23. How easily do you make friends in a strange situation?
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24. When highly stressed, how likely are you to ask friends or relatives for help?
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25. In comparison with other people, how likely are you to see others as threatening, uncooperative, or exploitative?
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26. How often are you confused about the intentions of others toward you?
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27. To what extent are you aware of practical, healthy ways of relaxing?
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28. How frequently do you pursue some highly relaxing practice?
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29. How often do you engage in a spiritual practice such as prayer, mediation, or inspirational reading to enrich your interior life?
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Please select a number
30. How connected do you feel to your conception of a higher power or to a worthy cause?
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31. To what extent do you believe your life has purpose?
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Please select a number
32. How much contact do you have with what you would consider a spiritual community?
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Please select a number
