Self-Care Assessment

 

Based on your results, we will send you a self-care tool you will love

Name *
Name
Fill out the following self-care assessment and we will send you a self-care tool you will love! Feel free to add areas of self-care that are relevant for you and rate yourself on how often and how well you are taking care of yourself most days. When you are finished, look for patterns in your responses as the process of developing good self-care begins with self-awareness and self-assessment - You know yourself best! Are you more active in some areas of self-care but ignore others? Are there items on the list that make you think, "I would never do that"? Listen to your inner responses, your internal dialogue about self-care and making yourself a priority. Take particular note of anything you would like to include more in your life.
Strongly Disagree = This never occurred to me Disagree = I never do this Neutral = I rarely or barely do this Agree = I do this OK (e.g., occasionally) Strongly agree = I do this well (e.g., frequently)
Survey
Survey
Physical Self-Care
Eat regularly (e.g. breakfast, lunch, and dinner)
Eat healthily
Exercise
Make time for my ongoing disease management/health promotion
Get regular medical care for prevention - natural or over-the-counter
Get medical care when needed - prescription or recommendation from holistic provider
Take time off when sick
Get massages
Dance, swim, walk, run, play sports, sing, or do some other fun movement
Say no to extra responsibilities sometimes
Other:
Emotional Self-Care
Spend time with others whose company I enjoy
Stay in contact with important people in my life
Give myself affirmations, praise myself
Love myself
Re-read favorite books, re-watch favorite movies
Identify comforting activities, objects, people, places and seek them out
Allow myself to cry
Find things that make me laugh
Express my outrage in social action, letters, donations, marches, protests
Other:
Spiritual Self-Care
Make time for reflection
Spend time in nature
Find a spiritual connection or community
Be open to inspiration
Cherish my optimism and hope
Be aware of non-material aspects of life
Try at times not to be in charge or the expert
Be open to not knowing
Identify what is meaningful to me and notice its place in my life
Meditate
Pray
Sing
Have experiences of awe
Contribute to causes in which I believe
Read inspirational literature or listen to inspirational talks, music
Other:
Relationship Self-Care
Schedule regular dates with my partner or spouse
Schedule regular activities with children in my life
Make time to see friends
Call, check on, or see my relatives
Spend time with my companion animals
Stay in contact with faraway friends
Make time to reply to personal emails and letters; send holiday cards
Allow others to do things for me
Enlarge my social circle
Ask for help when I need it
Share a fear, hope, or secret with someone I trust
Other:
Workplace or Professional Self-Care
Take a break during the workday (e.g., lunch, water, outdoors, bathroom, dinner)
Take time to chat with co-workers
Make quiet time to complete tasks
Identify projects or tasks that are exciting and rewarding
Set limits with clients and colleagues
Balance my workload so that no one day or part of a day is “too much”
Arrange work space so it is comfortable and comforting
Get regular supervision or consultation or support
Negotiate for my needs (benefits, pay raise)
Have a peer support group
Develop an area of interest that is not personal or traumatic
Overall Balance
Strive for balance within my work-life and work day
Strive for balance among work, family, relationships, play, and rest
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