Questionnaire

Are you overwhelmed, stressed out, or having trouble coping? Many people today are having difficulty coping with something! In fact, more people than ever before are suffering from prolonged stress (from a variety of circumstances), one of the key villains in stress-related illnesses. The good news is that the Center for Coping has action-oriented methods and strategies which, when properly learned, can really help you to improve your quality of life… and enhance your well-being!

To help us determine the problems you’re dealing with and how well you’re coping with them, please complete the following “Personal Well-Being Evaluation” questionnaire. Then click the “send” button, and it will automatically be sent to one of our professionals for a thorough evaluation and interpretation of your well-being score.

The professional who evaluated your questionnaire will then contact you to set up a free, no-obligation appointment to discuss what your scores revealed and what your well-being level is. In addition, you’ll receive valuable suggestions for things you can do to immediately start improving the quality of your life. This entire process is strictly CONFIDENTIAL and totally FREE OF CHARGE.

Of course, in order for us to provide you with a realistic and helpful evaluation, we ask that you answer the following questions honestly and accurately. Again, confidentiality is assured.

Now, take your first step to helping yourself!

Click here to complete the questionnaire!

Personal Well-Being Evaluation

Directions: Considering the timeframe of the past month, answer each of these questions as honestly and accurately as you possibly can. Answer quickly with the first answer that comes into your mind by clicking on the most appropriate circle.

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1. how are you?
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3. First Name
4. Last Name
5. Age
6. Phone
7. E-mail
8. Please indicate how you would like to be contacted:
9. hloooo?
10.
Name
Email
Phone