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Free Sterling Practice Stress Analysis

How much can you take?

Name: 
Title: 
Specialty:  # of Staff:
E-mail: 
Address: 
City:     State:  Zip:
Office Phone: 
Home Phone:  (optional)
How did you hear about us?

+  (Plus) means I AGREE, YES or MOSTLY YES
M  (Middle) means UNCERTAIN, MAYBE, NEITHER YES nor NO
-  (Minus) means I DISAGREE, NO or MOSTLY NO

1.  I often feel guilty about not spending more time with my family.
+ M –
2. There are influences outside my practice that demand my attention right now.
+ M –
3. There's quite a bit of stress in my life.
+ M –
4. I'm concerned about my health at times.
+ M –
5. There are too many accidents/mistakes in my life.
+ M –
6. I have one or more physical problems.
+ M –
7. Others have influenced me in making decisions that I later regretted.
+ M –
8. I sometimes experience periods of worry and depression.
+ M –
9. The rewards of operating my practice far outweigh the difficulties.
+ M –
10.  Someone or something else is responsible for the condition my practice is in.
+ M –

Once we have received your answers, a service consultant will contact you within 24-48 hours, Mon.-Fri., with your test results.

 

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