Autonomic Function & Stress Physiology Questionnaire

Stress & Wellness
Assessment

Self-Assessment Tool

Chronic stress is one of the most overlooked barriers to better health. Even when people are doing everything “right” — eating well, exercising, taking supplements — unmanaged stress can quietly undermine every effort. It disrupts hormones, impairs recovery, fragments sleep, and shifts the body into a state where fat loss, energy, and performance all suffer.

True wellness isn’t just about what you eat or how you train. It requires a plan that addresses stress at its root. This assessment is designed to help identify how chronic stress may be affecting your body’s systems — and to highlight where targeted support could make the biggest difference.

Scoring Guide
0
Never
1
Occasionally
2
Often
3
Always

Sympathetic Dominance Symptoms

Score
0123
I feel wired but tired
I have difficulty relaxing even when I try
My mind races at night
I wake between 2–4 AM
I rely on caffeine to function
I feel worse after intense workouts (not better)
I experience frequent anxiety or internal tension
I clench my jaw or hold tension in my body
🔥

Metabolic / Body Composition Clues

Score
0123
I am eating less but not losing fat
I have central (abdominal) fat gain
I feel shaky or irritable if I don’t eat
I crave sugar or salt, especially at night
My weight fluctuates easily with stress
🏃

Recovery & Training Response

Score
0123
My performance is stagnant or declining
I feel sore longer than expected
My motivation to train is decreasing
I feel drained after workouts
I’m training hard but not seeing body composition changes
🌙

Sleep & Circadian Disruption

Score
0123
I have trouble falling asleep
I wake up unrefreshed
I feel more alert at night than in the morning
I use screens late at night
My sleep feels light or fragmented
🫀

Autonomic Dysfunction Indicators

Score
0123
I have cold hands or feet / temperature dysregulation
I feel dizzy when standing up
I experience digestive issues (bloating, slow motility)
I have low HRV if tracked
I tend to breathe shallowly or hold my breath
Total Score Autonomic Load Index
/ 84

This questionnaire is for educational and informational purposes only and does not constitute medical advice or diagnosis. Please consult a qualified healthcare professional regarding any health concerns.

Thank you for completing the questionnaire.