Family Stress Survey Questionnaire
Help us understand your family's experience with stress. Please answer the following questions honestly. Your responses are confidential and will be used for research and support purposes only.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
What is your relationship to the family?
*
Parent/Guardian
Child/Teenager
Other Adult
Other
How many people live in your household?
*
In the past month, how often has your family experienced stress?
*
Never
Rarely
Sometimes
Often
Almost always
Please rate the following sources of stress for your family.
*
Rows
Not at all stressful
Slightly stressful
Moderately stressful
Very stressful
Extremely stressful
Financial concerns
1
2
3
4
5
Work or school demands
6
7
8
9
10
Health issues
11
12
13
14
15
Relationship conflicts
16
17
18
19
20
Parenting challenges
21
22
23
24
25
Household responsibilities
26
27
28
29
30
How would you rate the overall stress level in your family?
*
1
2
3
4
5
Which coping strategies does your family use when dealing with stress? (Select all that apply)
*
Talking openly about problems
Spending time together
Seeking outside help (counseling, therapy)
Physical activities/exercise
Avoiding the issue
Other
To what extent has stress affected the following aspects of your family life?
*
Rows
Not at all
A little
Somewhat
A lot
Completely
Communication
31
32
33
34
35
Emotional well-being
36
37
38
39
40
Physical health
41
42
43
44
45
Family routines
46
47
48
49
50
Ability to solve problems
51
52
53
54
55
How confident are you in your family's ability to manage stress in the future?
*
Not confident at all
1
2
3
4
Very confident
5
1 is Not confident at all, 5 is Very confident
Please share any additional comments or experiences about family stress.
Submit Survey
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