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* 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.)

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

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* Please re-enter your email address

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* Please enter your age in years.

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* Your sex

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* Your marital status:

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

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