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.