Self-Care Assessment Test
Evaluate Your Level Of
Self-Care Practices
Answer each question then check you results below. You can either complete the form online or print it off
Assessment Questions
PART 1
- Can you make and take time for you without feeling pangs of guilt?
Yes ____
No ____
- Are your leisure activities a priority in your life?
Yes ____
No ____
- Do you know what your needs are?
Yes ____
No ____
- Do you take care of your needs and desires?
Yes ____
No ____
- Do you regularly make some time for “me time”?
Yes ____
No ____
- Do you feel okay about sometimes slowing down?
Yes ____
No ____
7. Do you understand the difference between self-indulgence and self-care?
Yes ____
No ____
- Do you feel as though you deserve self-care?
Yes ____
No ____
PART 2
- Do you say yes to requests from others when it is best for you to say no?
Yes ____
No ____
- Do you constantly worry about everyone else, and not about yourself?
Yes ____
No ____
- Do you do things that you really don’t want to do, or that will over extend you?
Yes ____
No ____
- Are you running on empty?
Yes ____
No ____
- Are you stressed out a lot of the time?
Yes ____
No ____
- Are you overwhelmed?
Yes ____
No ____
- Do you suffer from headaches?
Yes ____
No ____
- Do you suffer from insomnia?
Yes ____
No ____
- Are you chronically tired and have a lack of energy?
Yes ____
No ____
- 10.Do you crave and eat junk food often, and especially during times of stress?
Yes ____
No ____
Score Your Results
- Part 1
Each NO answer = 1 point
Each YES answer = 0 points
Add up your score for Part 1
Total Score Part 1: ___________
- Part 2
Each NO answer = 0 points
Each YES answer = 1 point
Add up your score for Part 2
Total Score Part 2: ___________
- Add up both scores for Part 1 and Part 2
Total Score Part 1 + Part 2 = _________
RESULTS
If you scored 6 or more points, you can benefit from addressing your self-care practices and making a self-care plan.
The higher your point value, the more imperative it is that you address your self-care needs.
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