Self-Care Assessment

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Use the rate key below to respond to each statement, combine the total of your responses to determine your score

Rating Key:

1-Rarely/Never

2- Sometimes

3- Frequently

4- Regularly

5- Always

This key can be used to calculate your results based on the number rating used to respond to

each statement.

Score Key

40-50: Self Care Sovereign

28-40: Working on Me

10-28: Time for a Check-in

*This assessment is for educational purposes only, and is the intellectual property of Acho-Tea Talk Coaching, therefore it should not be used or duplicated in anyway with out the expressed permission of Acho-tea Talk Coaching and it's owners.

Email *

I keep up a self maintenance regimen, included in my daily/weekly routine.

Rarely/Never

Always

I care for myself with as much intention as I do for others under my care. *

Rarely/Never

Always

I am conscious of my desires and needs. *

Never/Rarely

Always

I am able to communicate my needs and desires. *

Never/Rarely

Always

I consistently and intentionally take steps to meet my needs and desires. *

Never/Rarely

Always

I feel connected and firmly rooted in my body. *

Never/Rarely

Always

I place equal importance on my feelings and those of others. *

Never/Rarely

Always

I am accepting and loving of myself, and I understand that I am a work in progress. *

Never/Rarely

Always

I think it's ok to make mistakes and not be the best.
*

Never/Rarely

Always

I deserve good things in my life.
*

Never/Rarely

Always

Send me a copy of my responses.

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