Self-Care Assessment Worksheet

GinaMarie Guarino, LMHC GinaMarie Guarino, LMHC

Worksheet published on June 7th, 2019

Worksheet updated on June 20th, 2019

Self-Care Assessment Worksheet

Practicing proper self-care techniques is a very a important part of mental health. Without self-care, people cannot grow and learn how to cope with the stress of their daily lives. It is particularly important when someone is struggling with mental illness because it teaches skills to maintain good coping strategies and mental wellness.

Self-care is important, but is often not a priority for people who are struggling with stress or mental illness. A great way to begin the conversation about self-care is to introduce a self-care assessment to a client.

About This Worksheet

This is the Self-Care Assessment worksheet. This worksheet serves as a means to assess a client’s understanding of what self-care means, and their motivation to incorporate self-care into their lives.

This worksheet provides three sections of self-care questions for the client to answer. It serves as a baseline for taking the steps to explain the importance of self-care and skills needed to begin incorporating self-care into their daily routine.


This worksheet consists of 14 questions that are divided into 3 sections. Each section covers one of the following self-care topics:

  • The client’s understanding of the definition of self-care
  • The client’s perceived importance of self-care
  • The client’s motivation to incorporate self-care into day-to-day life

Instruct the client to complete the questions provided on the worksheet:

  • In section 1, the client is instructed to complete the sentences by filling in their response.
  • Section 2 consists of reflection questions about their perspective of self-care.
  • Section 3 provides questions to assess how often the client engages in behaviors that affect their ability to maintain self-care.

Once the worksheet is complete, review the results with the client. Develop a plan of action to incorporate self-care skills into their daily routine. This worksheet is great for adolescents and adults. It can be used in individual counseling, family therapy, couples counseling and group counseling sessions.

Download Self-Care Assessment Worksheet

Link To This Worksheet

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