Zuvina Stress & Sleep Assessment

Answer a few quick questions to help us understand how stress and sleep are affecting you. This is for general wellness guidance only and does not provide any medical diagnosis.

1. Which of the following best describes what’s bothering you recently?

You can choose up to 2.

I feel emotionally tense or easily irritated
I feel low, unmotivated, or mentally tired
I have trouble sleeping, wake up at night, or sleep lightly
I often feel chest tightness or sigh frequently
My mind feels foggy, and my focus is poor
I feel warm inside, restless, or get thirsty at night
My hands and feet tend to feel cold
My digestion feels weak (bloating, poor appetite)

Required. Please choose 1–2 options.

2. Which of these do you experience?

Select all that apply.

I often feel tired or mentally drained
My appetite is poor or I feel bloated easily
I wake with a dry mouth or sweat at night
My throat feels stuck or phlegmy
My hands or feet get cold
I feel warm in the face or easily flushed
My sleep gets worse when stressed

3. Under stress, you tend to:

Select all that apply.

Become irritable or easily frustrated
Feel nervous or experience palpitations
Have trouble sleeping
Feel chest tightness or want to sigh
Become extremely tired
Have emotional swings or PMS-related irritability
Feel inner heat, restlessness, or agitation

4. What would you most like to improve right now?

Choose one.

Relax and calm my emotional tension
Lift my mood and improve mental energy
Sleep deeper and wake up less at night

Required.