Please download and complete the questionnaire
When you have completed this form either move on to the answer sheet below to get an understanding of what your score means or return your completed form to your coach ; email: [email protected] who will review your score and revert to you.
If you have any concerns in relation to your score feel free to email your coach for further discussion.
Holmes and Rahe Social Readjustment Rating Scale
Name………………………………………………………………………………………………………………………….
LIFE EVENT VALUE
| Death of a Spouse
Divorce Marital Separation Prison Term Death of a close family member Personal injury or illness Marriage Sacked from work Marital Reconciliation Retirement Change in family member’s health Pregnancy Sex difficulties Addition to family Business Readjustment Change in Financial Status Death of a Close Friend Change to a different type of work Change in number of marital arguments Mortgage or large loan Foreclosure of mortgage or loan Change in work responsibilities Trouble with in-laws Outstanding personal achievement Spouse begins or stops work Starting or finishing education Change in living conditions Revision of personal habits Trouble with the boss Change in work hours or conditions Change in residence Change in educational establishment Change in church activities Change in social activities Small mortgage or loan Change in sleeping habits Change in number of family gatherings Change in eating habits Holiday Minor Breach of the law |
100
73 65 63 63 53 50 47 45 45 44 40 39 39 39 38 37 36 36 31 30 29 29 28 26 26 25 24 23 20 20 20 19 18 17 16 15 15 13 11 |
| TOTAL |
When you have completed this form either move on to the answer sheet below to get an understanding of what your score means or return your completed form to your coach ; email: [email protected] who will review your score and revert to you.
If you have any concerns in relation to your score feel free to email your coach for further discussion.
