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First name

Last name

Email

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What are the main sources of stress and energy drain in your life? (You can choose multiple)

How taxing are these things on you and your life?

1 It's pretty insignificant and totally under control

2 It can be annoying or bothersome at its worst

3 It is a constant drain, but manageable

4 It is extremely difficult to deal with and is almost unmanageable

5 It's ruining my life and is a living nightmare

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