Self-Care Assessment

How often do you eat regularly (e.g. breakfast, lunch, and dinner)?

• Frequently

• Occasionally

• Never

How often do you exercise?

• Frequently

• Occasionally

• Never

How often do you do something for fun (e.g. walking, running, dancing)?

• Frequently

• Occasionally

• Never

How often do you do get enough sleep?

• Frequently

• Occasionally

• Never

How often do you do you make time for self-reflection?

• Frequently

• Occasionally

• Never

How often do you try not to be in control of everything?

• Frequently

• Occasionally

• Never

How often do you do something you let others know a different side of you?

• Frequently

• Occasionally

• Never

How often do you say "no" to extra responsibilities?

• Frequently

• Occasionally

• Never

How often do you allow yourself to cry?

• Frequently

• Occasionally

• Never

How often do you strive for balance among work, family, relationships, play, and rest?

• Frequently

• Occasionally

• Never