Phone

(732) 285-4184

Email

info@cNJacu.com

1 Bethany Rd, Ste 83, Hazlet, NJ 07730

The Perceived Stress Scale (PSS) is a classic stress assessment instrument. This tool, while originally developed in 1983, remains a popular choice for helping us understand how different situations affect our feelings and our perceived stress. The questions in this scale ask about your feelings and thoughts during the last month. In each case, you will be asked to indicate how often you felt or thought a certain way. Although some of the questions are similar, there are differences between them and you should treat each one as a separate question. The best approach is to answer fairly quickly. That is, don't try to count up the number of times you felt a particular way; rather indicate the alternative that seems like a reasonable estimate.

Name*
Email*
Current Health Concern
1. In the last month, how often have you been upset because of something that happened unexpectedly?
2. In the last month, how often have you felt that you were unable to control the important things in your life?
3. In the last month, how often have you felt nervous and stressed?
4. In the last month, how often have you felt confident about your ability to handle your personal problems?
5. In the last month, how often have you felt that things were going your way?
6. In the last month, how often have you found that you could not cope with all the things that you had to do?
7. In the last month, how often have you been able to control irritations in your life?
8. In the last month, how often have you felt that you were on top of things?
9. In the last month, how often have you been angered because of things that happened that were outside of your control?
10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

## COVID-19 PROTOCOL

Central New Jersey Acupuncture & Wellness Clinic will not be treating any known, or suspected, cases of Covid-19 in the office.  If you are sick, please wait for 2 weeks until you are symptom free before making an appointment.

If you have been exposed to someone with Covid-19 in the past 14 days, we will not be able to accept you as a patient at this time. If you have traveled outside of the US in the past 30 days we will not be able to accept you as a patient at this time.

Following are our new procedures:

1. You will be pre-screened via phone prior to your appointment.

2. When you arrive at the office, please wait in your car and call the office. You will be told when it is safe to come in.

3. Upon entering the office, you will be required to hand sanitize. We will do a quick temperature check, if you are over 100.4F, you will be asked to leave and call your doctor. Temperature checks will be done at each visit.

4. All patients are required to wear a face covering of some kind the entire time you are in the office, for the duration of the treatment. We have masks available if you need one.

5. You will be taken to the treatment room directly. No waiting in the waiting room.

6. Follow up appointments can be scheduled prior to leaving the office.   You may also email info@cNJacu.com to set up your next appointment

Cleaning:

1. Tables are wiped down between treatments.

2. High tough surfaces- door handles, light switches, call buttons, etc will be sanitized between patients

3. Providers will wear masks and gloves while cleaning

4. Alcohol based hand sanitizers are available in all rooms.

What we need from you:

2. Please DO NOT bring unnecessary items into the office with you, i.e., purses, bags, water bottles, iPads, etc..  The fewer items you have the less likely we will have any issues with contamination.

3. Please DO NOT come to your appointment if you have, or have had, any cold or flu symptoms in the past 14 days, have traveled recently, or have any of the symptoms that are associated with Covid-19.   This applies if you have a household member with any symptoms.  We know that there are many silent carriers, but our goal is to minimize any exposure of known causes. Instead, call us to reschedule.

If you are uncomfortable coming to the office for any reason, we understand.

If any of us tests positive for Covid-19, the office will be closed for 14 days, disinfected, and all patients who have been in 14 days prior will be notified.

## Book an Appointment

### NEW PATIENT OFFER

New Patients Enjoy A $40 Initial Consultation Normally$240. Save \$200.