Stress Scan Report

Session Number*
Coach Name*
First Last
Coachee Name*
First Last
Date of testing*
DD slash MM slash YYYY
Number of hours sleep last night?*
1. What was the quality of the sleep?*
Please enter a number from 0 to 10.
Poor <----> Excellent
0 1 2 3 4 5 6 7 8 9 10
2. Have you taken any medication today? YES/NO*

If YES, what is it and what is it for?
3. Have you had any drinks today? e.g. coffee, tea, hot chocolate, etc.*

If YES, what...?
4. Right now do you have any pain?*

No Pain <-> Extreme Pain
0 1 2 3 4 5 6 7 8 9 10
If YES, please describe
5. Do you have any injuries? YES/NO*

If YES, what are they?
6. Right now, what is your stress level?*

No Stress <-> Very Stressed
0 1 2 3 4 5 6 7 8 9 10
If you are above 5, please explain.
7. Overall, how well (physically and mentally) do you feel?*

Very Poor < - > Excellent
0 1 2 3 4 5 6 7 8 9 10
Relaxation*
Activation*
Overall*
9. Key Observations if any