Body Relaxation Assessment
Please complete this assessment to help us evaluate your current level of body relaxation and identify areas for improvement.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
On a scale of 1 to 10, how relaxed do you feel right now?
*
Not relaxed at all
1
2
3
4
5
6
7
8
9
Completely relaxed
10
1 is Not relaxed at all, 10 is Completely relaxed
Please rate the level of relaxation you feel in the following areas of your body:
*
Rows
Very Tense
Somewhat Tense
Neutral
Somewhat Relaxed
Very Relaxed
Neck and Shoulders
1
2
3
4
5
Back
6
7
8
9
10
Arms and Hands
11
12
13
14
15
Legs and Feet
16
17
18
19
20
Jaw and Face
21
22
23
24
25
Which of the following activities have you practiced in the last week to promote relaxation? (Select all that apply)
*
Breathing exercises
Yoga or stretching
Meditation or mindfulness
Listening to calming music
Taking a warm bath
None of the above
Other
How often do you experience muscle tension or discomfort during a typical week?
*
Rarely (less than once a week)
Occasionally (1-2 times a week)
Frequently (3-5 times a week)
Almost daily
Please rate your overall stress level during the past week.
*
1
2
3
4
5
What time of day do you usually feel most relaxed?
*
Please Select
Morning
Afternoon
Evening
Night
No particular time
Do you have any specific areas of your body where you consistently feel tension?
*
Yes
No
If yes, please specify the areas where you feel tension.
Please describe any habits or activities that help you relax effectively.
Do you have any suggestions or feedback to help us improve our relaxation assessment or services?
Submit Assessment
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