Param Ayurveda

Know your Mental Stress %

PARAMETER TO ASSESS STRESS: Mental stress %

SUBJECTIVE CRITERIA - Ratings for Symptoms

Name:

Age:

Contact No:

Email Id:

Address:

Symptoms present in past month before Treatment

0- No, Not at all

1- Yes, Once or twice in month

2- Yes, Several times in month

3- Yes, Daily

A] Physical symptom

Headache:

Perspiring:

Fatigue:

Pain in muscle:

Shortness of Breath:

Palpitation:

Sleep Disturbance:

Digestive Disorder :

Missed periods and other reproductive problems:

Restlessness:

Tension and self consciousness when saying or doing something

Feeling too warm :

Feeling the need to go the rest room:

Feeling uncoordinated:

Dry mouth:

Feeling unfit or heavy :

Watering or tearing eyes :

Bruxism :

Worsened skin condition :

B] Intellectual Symptoms

Lack of Concentration :

Incapability to get rid of the negative thoughts:

Inability or difficulty in making decisions:

Perplexity (Confusion):

Weak Memory:

Inability to think creatively:

Errors in performance :

Inability to continue work or school:

Inability to form or keep satisfying relationships:

Inability to take care of oneself or others:

Decreased problem solving skills

C] Emotional Symptoms

Anxiety (Fearfulness , Tension):

Depression- (Sadness, shame, guilt, hopelessness & Sorrow):

Anger: (Fighting, Irritability, Cynicism ):

Fear:

Craving to cry :

Sudden shifts in mood:

Lack of interest in hobbies and fun among others:

D] Behavioral Symptoms

Frequent loss of temper:

Staying home from work or staying at work for extra hours:

Taking unnecessary risks :

Grinding teeth :

Become violent :

Addiction :

Argue with family & friends :

More or less sexual activity :