First Name *

Last Name *

Email *

Phone *

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Emotional Drain Frequency *

Rarely

Occasionally

Sometimes

Often

Constantly

Emotional Drain Intensity

Mild

Manageable

Noticeable

Intense

Overwhelming

Stress-Affected Areas

Personal relationships

Physical health

Decision-making

Long-term vision

Stress Impact

Minimal

Low

Moderate

High

Severe

Motivation to Improve

Not motivated

Slightly motivated

Somewhat motivated

Motivated

Very motivated

Which stress factor impacts you the most?

Priority Stress Factors

Time pressure

Team conflicts

Self-doubt

Overcommitting

Resolvability

Not solvable

Difficult to solve

Possible with effort

Solvable

Easily solvable

Control

No control

Limited control

Some control

Considerable control

Full control

Which emotions do you feel most frequently in your role? (Select up to 3)

Emotional Range

Anxiety

Frustration

Satisfaction

Gratitude

Hopelessness

Emotional Impact

Minimal impact

Low impact

Moderate impact

High impact

Dominating impact

Time Dominance

Rarely

Occasionally

Sometimes

Often

Constantly

How well-integrated do you feel your professional and personal lives are?

Work-Life Balance

No balance

Minimal balance

Moderate balance

Good balance

Perfect harmony

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