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Baseline Assessment

Track your stress, energy, and symptoms over time. Complete this assessment at Week 0, Week 4, Week 8, and Week 12 to measure your progress through the program.

When to Complete: Take this assessment at the start of the program (Week 0), then again at weeks 4, 8, and 12 to track changes. Be honest—this is for your benefit, and no one else will see it.

Assessment Date

Overall Stress Level (0-10)

0 1 2 3 4 5 6 7 8 9 10

Physical Fatigue Level (0-10)

0 1 2 3 4 5 6 7 8 9 10

Mental/Emotional Fatigue (0-10)

0 1 2 3 4 5 6 7 8 9 10

Sleep Quality (0-10)

0 1 2 3 4 5 6 7 8 9 10

Ability to Concentrate (0-10)

0 1 2 3 4 5 6 7 8 9 10

Sense of Control Over Stress (0-10)

0 1 2 3 4 5 6 7 8 9 10

Confidence in Managing Stress (0-10)

0 1 2 3 4 5 6 7 8 9 10

Physical Symptoms Experienced (Past Week)

Check all that apply

Headaches

Muscle tension

Digestive problems

Racing heart

Chest tightness

Chronic fatigue

Sleep problems

Appetite changes

Top 3 Current Stressors

One per line

Your Assessment History