Stress & Recovery Questionnaire

Date / Time

Name *

First

Last

Email *

Phone

Do you work shift work?

Yes
No

Sleep Habits & Quality

Think about your sleep habits and quality right now.

On average, how many hours per night do you sleep?

What is your typical bed time?

How good is your sleep quality?

What tends to interfere with you getting enough sleep, and / or the quality of your sleep?

What, if anything, tends to help you sleep better / longer?

Do you currently take any medications or natural health products to help yourself sleep?

Yes
No

If yes, please tell me more?

Stress Factors

Many things can cause us stress. Tick all that you’ve experienced in the last six months.

Checkboxes

Please use this box for other stress factors not listed or to share further details

Considering all these factors, how would you rank your overall level of stress right now?

Considering all these factors, how well would you say you’re coping right now?

What, if anything, do you do right now to cope and / or recover from stressors?

Include physical, mental, and emotional recovery strategies

How physically energetic and vital do you normally feel on an average day?

On an average day, do you have any persistent pain, soreness, stiffness, aching, etc.?

Yes
No

If yes, how bad is it?

How mentally “sharp”, quick, and clear do you normally feel on an average day?

How happy and cheerful do you normally feel on an average day?

Today, how interested are you in exercise and / or training? How excited to train?

For women: If you should be having regular periods, are you? If no, how long has it been since your last period?

Yes
No

Use this area to expand on this if needed

Resting heart rate

Record your resting heart rate before getting out of bed. Use a smart watch or place your forefingers on your carotid artery (neck) or radial artery (wrist) and count the beats for 60 seconds. Record the amount below.

Morning body temperature

Record your morning body temperature immediately on waking. Record the figure below

Stress & Recovery Questionnaire

Sleep Habits & Quality

Stress Factors

Coaching

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