Stressors Questionnaire Posted on April 4, 2023 by Courtney Lundeen Welcome to your Stressors Questionnaire Name Email Do you experience symptoms of hypoglycemia such as dizziness, shakiness, or brain fog between or following meals? Yes No Do you frequently miss or delay meals? Yes No Do you frequently crave sugar or cabohydrates? Yes No Do you consume excessive sugar or refined carbohydrates? Yes No Are you diabetic or pre-diabetic? Yes No Do you regularly consume alcohol or caffeine? Yes No Do you consume food within 2 hours before bedtime? Yes No Do you frequently experience anxiety? Yes No Do you suffer from depression? Yes No Do you suffer from mood swings? Yes No Do you have difficulty getting motivated? Yes No Do you frequently experience feelings of agitation, anger, fear or worry? Yes No Do you consider your job, relationships, or finances stressors in your daily life? Yes No Are you a caregiver for a parent or disabled child or other person? Yes No Are you experiencing problems falling asleep? Yes No Are you experiencing difficulty staying asleep? Yes No Are you sleeping less than 7 hours each night? Yes No Do you awaken not feeling well-rested in the morning? Yes No Do you work 2nd or 3rd shift or keep late night hours? Yes No Do you use electronic devices within 2 hours before bed? Yes No Do you eat within 2 hours of bedtime? Yes No Do you frequently feel drowsy throughout the day? Yes No Do you snore? Yes No Do you suffer from headaches, muscle, back or joint pain? Yes No Do you suffer from IBS, Crohn's Disease or diverticulitis? Yes No Do you suffer from hives, eczema or psoriasis? Yes No Do you suffer from asthma, bronchitis, seasonal allergies or hay fever? Yes No Do you suffer from any autoimmune condition such as MS, lupus or rheumatoid arthritis? Yes No Do you suffer from food allergies, chronic infections or frequent illness? Yes No Time is Up! Time's up
