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

  1. Can you make and take time for you without feeling pangs of guilt? 

Yes ____

No ____

  1. Are your leisure activities a priority in your life? 

Yes ____

No ____

  1. Do you know what your needs are?

Yes ____

No ____

  1. Do you take care of your needs and desires?

Yes ____

No ____

  1. Do you regularly make some time for “me time”?

Yes ____

No ____

  1. Do you feel okay about sometimes slowing down?

Yes ____

No ____

7. Do you understand the difference between self-indulgence and self-care? 

Yes ____

No ____

  1. Do you feel as though you deserve self-care? 

Yes ____

No ____

 

PART 2

  1. Do you say yes to requests from others when it is best for you to say no?

Yes ____

No ____

  1. Do you constantly worry about everyone else, and not about yourself?

Yes ____

No ____

  1. Do you do things that you really don’t want to do, or that will over extend you?

Yes ____

No ____

  1. Are you running on empty? 

Yes ____

No ____

  1. Are you stressed out a lot of the time?

Yes ____

No ____

  1. Are you overwhelmed?

Yes ____

No ____

  1. Do you suffer from headaches?

Yes ____

No ____

  1. Do you suffer from insomnia?

Yes ____

No ____

  1. Are you chronically tired and have a lack of energy? 

Yes ____

No ____

  1. 10.Do you crave and eat junk food often, and especially during times of stress?

Yes ____

No ____

Score Your Results

  1. Part 1
    Each NO answer = 1 point
    Each YES answer = 0 points

Add up your score for Part 1

Total Score Part 1: ___________

  1. Part 2

Each NO answer = 0 points
Each YES answer = 1 point

Add up your score for Part 2

Total Score Part 2: ___________

  1. 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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