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Adrenal Stress Profile Questionnaire

This short questionnaire will help Dr. Zac Watkins learn more about how well your body is responding to stress. Consider each question carefully, then click the appropriate button to indicate how well the question describes you.

It is important to note that this is not a diagnostic test and should not be used to diagnose any conditions. It is simply a tool to help assess your likely level of adrenal fatigue. You will be able to see your total score and additional information about your results on the next page once you click the "My Adrenal Score" button.

Note: All fields are required.

   
 
    First Name  
 
    Last Name  
 
    Your Email  
 
 
Yes
No
    1. Do you frequently have low body temperatures? (<98 degrees F)
    2. Do you frequently get irritable?
    3. Do you have poor memory or concentration?
    4. Do you notice palpitations (rapid, strong, or irregular heartbeat)?
    5. Do you suffer from allergies or asthma?
    6. Do you bruise easily or find your wounds heal slowly?
    7. Do you get frequent/chronic infections?
    8. Do you have dry, thinning skin?
    9. Do you get headaches?
    10. Do you have unexplained hair loss?
    11. Do you skip meals?
    12. Do you exercise less than twice each week?
    13. Do you have thyroid problems?
    14. Do you lack energy (feel tired) during the day?
    15. Do you usually go to bed after 10 pm?
    16. Do you need caffeine in the morning or after lunch?
 
 
Yes
No
    17. Do you feel your sex drive is lower than it used to be?
    18. Do you get tenderness across your lower back?
    19. Do you suffer from depression or down moods?
    20. Do you crave sweets?
    21. Do you have low blood pressure?
    22. Do you experience a “second wind” (high energy) at bedtime?
    23. Do you experience chronic or recurrent inflammation?
    24. Do you get light headed when sitting up or standing?
 
 
Yes
No
    25. Do you suffer from chronic pain?
    26. Do you suffer from low blood sugar/hypoglycemia?
    (i.e. headaches, sleepiness, mood swings if skipping meals)
    27. Do you suffer from insomnia? (problems falling or staying asleep)
    28. Are you emotionally overstressed?
    29. Do you experience symptoms of PMS?
    (breast tenderness, abdominal cramping, heavy periods, mood swings)
    30. Are you menopausal or peri menopausal?
    (skipped periods, between 45-55 yrs old, hot flashes, vaginal dryness)