Exit this survey >>

Preventive Measures Computerized Stress Inventory -- Professional Version

Question Title

* Please enter the name of the program, health or mental health center, office, or business where you signed up to take this stress assessment.

Question Title

* Please enter Your Name or Code Number.
(You may use your real name, a pseudonym, or a code number. Make a note somewhere else of the name or number you use so that you will be able to identify your Stress Profile.)

Question Title

* Please enter your email address (so we can send your stress profile to you).

Question Title

* Please re-enter your email address

Question Title

* Please enter your age in years.

Question Title

* Your sex

Female

Male

Question Title

* Your marital status:

Single

Married, for the first time

Remarried

Divorced

Separated

Living with a lover

Widowed

Question Title

* Are you currently involved in a primary or special relationship?

Yes

No