Activity Level Name *Phone *Email Address *Date of Birth *Referring Doctor and Purpose1. I am a calm person. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)2. I get flustered if I have several things to do at once. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost)3. Sudden changes of any kind produce an immediate emotional effect on me. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)4. Strong emotions carry over for one or two hours after I leave the situation which caused them. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)5. I am restless and fidgety. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)6. My mood is quickly influenced by entering new places. *Never (Almost Never)SeldomOccasionallyFrequentlyAlways (Almost Always)7. I get excited easily. *Never (Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)8. I find that my heart keeps beating fast for a while after I have been “stirred up”. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Almost Always)9. I can be emotionally moved by what other people consider to be simple things. *Never (Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)10. I startle easily. *Never (Or Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)11. I am easily frustrated? *Never (Almost Never)SeldomOccasionallyFrequentlyAlways (Almost Always)12. I tend to remain excited or moved for a long period of time after seeing a good movie. *Never (Almost Never)SeldomOccasionallyFrequentlyAlways (Or Almost Always)Arousal Predisposition Scale By Stanley Coren - Arousal Level (Out of 60) HIGH AROUSAL = 44 - 55; LOW AROUSAL = 23 - 27.SUBMITPlease do not fill in this field.
