Self-Care Assessment Form (Page 2 of 3) in pdf

Self-Care Assessment Form Page 2

____ 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-view 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 my children

____ 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:

Self-Care Assessment Form Page 2