Personal Information

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Survey

Answer each question according to the following scale:

1) Never/Very Rarely 2) Rarely 3) Occasionally
4) Usually 5) Always

Are you working harder and accomplishing less?

1 2 3 4 5

Do you notice that you have a rapid pulse?

1 2 3 4 5

Are you frustrated at others' behaviors (e.g., become irritated when driving behind a slow driver or in a line of customers at the checkout counter)?

1 2 3 4 5

Are you seeing close friends/family members less frequently?

1 2 3 4 5

Do you have aches, pains and headaches often?

1 2 3 4 5

Do you forget deadlines, appointments and personal possessions?

1 2 3 4 5

Are you increasingly irritable and short-tempered?

1 2 3 4 5

Do you feel sad, discouraged or unenthusiastic?

1 2 3 4 5

Do you get upset if a joke is made about you?

1 2 3 4 5

Are you avoiding tasks and responsibilities?

1 2 3 4 5

Do you tire more easily?

1 2 3 4 5

Are you easily irritated with the mistakes of others?

1 2 3 4 5

Are you too busy to do things that once brought you pleasure?

1 2 3 4 5

Do you feel impatient with the rate at which events take place?

1 2 3 4 5