Self-Care Survey

Front

I take time for myself every day.

Back

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Front

I make time for my spirituality (in any form) mindfulness, or religious discipline.

Back

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Front

I limit the amount of television I watch each day.

Back

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Front

I limit the amount of facebook/internet surfing I do each day.

Back

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Front

I exercise 5 days per week for 30 minutes.

Back

5

Front

I drink 6-8 glasses of water per day.

Back

6-8 glasses of water per day.

Front

I get 7-8 hours of sleep per night.

Back

5, 4, 3, 2, 1

Front

I brush & floss my teeth.

Back

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Front

I eat at least 5 fruits/veggies per day.

Back

5

Front

I limit junk food/fast food.

Back

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