Please take a few moments to answer these questions to the best of your ability
Answer each question according to the following scale:
1) Never/ very rarely
2) Rarely
3) Occasionally
4) Usually
5) Always
About Your Stress
I feel relaxed 1 2 3 4 5
I sleep well at night 1 2 3 4 5
I choose nutritious foods 1 2 3 4 5
I am able to focus 1 2 3 4 5
I am energetic 1 2 3 4 5
I am pain free 1 2 3 4 5
I have a feeling of well being 1 2 3 4 5
I have found this CD helpful 1 2 3 4 5
How many times did you listen to this CD? _________
Questions or comments: ___________________________________________________
________________________________________________________________________
Personal Information (optional)
Age: 18-30 31-50 51–70 70 +
Exercise per/week: 1-2 3-4 5-7 Gender: M / F
Thank you for taking the time to complete our questionnaire
____________________________
Name
____________________________
Date of birth
