Count the number of conditions that you have
experienced in the past two weeks.
___ I often feel shaky.
___ I have muscle tension.
___ I feel restless.
___ I am experiencing fatigue.
___ I have shortness of breath.
___ I experience palpitations or accelerated heart rate.
___ I have sweaty or cold, clammy hands.
___ I experience dry mouth.
___ I feel dizzy or lightheaded.
___ I experience or abdominal distress.
___ I have hot flashes or chills.
___ I experience frequent urination.
___ I feel keyed up or on edge.
___ I get startled easily.
___ My mind goes blank and I can’t concentrate.
___ I have trouble falling or staying asleep.
___ I feel irritable.
___ I obsess over my worries.
___ I have racing thoughts.
If you have at least six of the above symptoms, brief
therapy can help you to identify the sources of your
stress, acquire the tools to become stress resilient,
and restore your physiological equilibrium. If you have
experienced these for more than a year, you are
placing yourself in danger of serious medical
complications and need an immediate consult with a
therapist, and possibly a primary care physician.
Please note the following that apply to you:
I would like to:
___ increase my sense of wellbeing and happiness.
___ have more peace of mind.
___ have more energy throughout the day.
___ attain more balance in my life.
___ experience fewer headaches
___ have more success in my weight loss program.
___ finally complete a project or goal that I have been
putting on the back burner.
If you are interested in any of the above goals, than
you are a good candidate for working with a coach. A
coach can help you determine a plan to take you from
where you are now to where you want to be.
If you are interested in both therapy and coaching, it is
advisable to pursue therapy prior to coaching. When
you have less anxiety, you are in a better position to
actualize your coaching goals.
Teresa Trower LMHC
(904) 868-0717
experienced in the past two weeks.
___ I often feel shaky.
___ I have muscle tension.
___ I feel restless.
___ I am experiencing fatigue.
___ I have shortness of breath.
___ I experience palpitations or accelerated heart rate.
___ I have sweaty or cold, clammy hands.
___ I experience dry mouth.
___ I feel dizzy or lightheaded.
___ I experience or abdominal distress.
___ I have hot flashes or chills.
___ I experience frequent urination.
___ I feel keyed up or on edge.
___ I get startled easily.
___ My mind goes blank and I can’t concentrate.
___ I have trouble falling or staying asleep.
___ I feel irritable.
___ I obsess over my worries.
___ I have racing thoughts.
If you have at least six of the above symptoms, brief
therapy can help you to identify the sources of your
stress, acquire the tools to become stress resilient,
and restore your physiological equilibrium. If you have
experienced these for more than a year, you are
placing yourself in danger of serious medical
complications and need an immediate consult with a
therapist, and possibly a primary care physician.
Please note the following that apply to you:
I would like to:
___ increase my sense of wellbeing and happiness.
___ have more peace of mind.
___ have more energy throughout the day.
___ attain more balance in my life.
___ experience fewer headaches
___ have more success in my weight loss program.
___ finally complete a project or goal that I have been
putting on the back burner.
If you are interested in any of the above goals, than
you are a good candidate for working with a coach. A
coach can help you determine a plan to take you from
where you are now to where you want to be.
If you are interested in both therapy and coaching, it is
advisable to pursue therapy prior to coaching. When
you have less anxiety, you are in a better position to
actualize your coaching goals.
Teresa Trower LMHC
(904) 868-0717
Stress Survey
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