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 respond to you, by your requested method of phone or email, to discuss what your scores revealed and what your well-being level is. In addition, you’ll receive some valuable suggestions for things you can do to immediately start improving the quality of your life. If you choose, you may then want to set up a free, no-obligation appointment to discuss how we can help you. 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 this easy step to begin helping yourself!

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.

Please check one response for each of the 20 items:

Please enter your email to receive the results of the questionnaire
Name
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1. How often do you experience parenting problems?
2. Do you believe your children have any “problems”?
3. Do you argue with your children?
4. Are you happy with your relationships with your children?
5. Are you consistent in the rules you set for your children?
6. Are you happy with your children’s personalities?
7. How often do you need to punish your children?
8. How often do your children depress you?
9. Does parenting come naturally to you?
10. Do you find it easy to talk to your children?
11. How often do your children follow rules that are set for them?
12. Do you feel overwhelmed by parenting responsibilities?
13. Do you get good reports from your children’s teachers?
14. Do you like your children’s friends?
15. How often do your children frustrate you?
16. Do you feel any guilt about how you’re raising your children?
17. Do your children listen to you?
18. How often do you regret having children?
19. Are your children able to tell you when things bother them?
20. Do you like spending time with your children?