APPENDIX A | Self-Care Questionnaire

You can choose to read this book in alphabetical order or prioritize certain chapters. This questionnaire is designed to help you discover the self-care areas that would benefit from your immediate attention vs. ones that you can work on later. Read each statement and decide if it fits best in the True or False category and click on the answer that most fits right now. Quickly decide if it is True most of the time or not.

This is for your eyes only or to share with your Accountability Partner. Answers are confidential and not saved on the website. The quality of your results will depend on how honest you are when answering. Do your best to answer quickly and not overanalyze the statements. Go with your first instinct.

After submitting all the questions in each of the six (6) Self-Care categories, then click on the last tile labeled “Self-Care Priorities” to finish up the questionnaire. It takes about 10-15 minutes to complete and you can print your results by clicking on the printer icon.

  • This field is for validation purposes and should be left unchanged.
  • This field is for validation purposes and should be left unchanged.
  • Prioritize

    The first self-care habit is to Act on Awareness and Acceptance. Therefore, when you have completed the entire questionnaire, become aware of the self-care categories that are your strengths and those that are your opportunities for improvement. First, reflect on your self-care strengths (all the False answers) and give yourself a pat on the back (literally) for making choices and taking action for your self-care. Next, reflect on your self-care opportunities (all the True answers). It is ok to have a few or many – accept this is as true based on where you are now. Give yourself another pat on the back (literally) for making choices and taking action to improve your self-care by reading this book. Finally, act – prioritize the self-care categories in the chart below based on your questionnaire responses and your gut instinct on which ones feel the most urgent. Your first priority category may or may not be the one with the most True responses. Once you've ranked the six self-care categories, take note of which chapters correspond to the self-care category using the chart Self-Care Categories and Related Chapters. This will help you keep track of which chapters support a category. I recommend reading or exploring the chapters associated with your top 3 self-care categories first. Then you can move into the chapters associated with your bottom 3 categories. Alternatively, you can simply read this book in chronological order without skipping around. Remember, the right approach is the one that works best for you. The key is to practice the self-care suggestions offered in each chapter. Your happiness, health and peace of mind depend on it!
  • Self-Care Priorities

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Self-Care Categories and Related Chapters


•   Embrace Enough-ness

•   Internally Validate

•   Make Peace with your Past

•   Prevent Perfectionism

•   Tame Anxiety


•   Act on Awareness and Acceptance

•   Just Start

•   Question Your Time Management

•    Watch Your Wallet



•  Discipline Yourself

•  Listen to Your Body

•  XOXO: Kiss(O) and Hug (X) Often





•  Choose Wisely

•   Have Healthy Self-Advocacy

•  Keep your Power

•  Reduce Stress

•  Yield to Positive Perspectives



•   Build Boundaries

•   Forgive

•   N-O is Your New Y-E-S

•  Observe Relationships

•   Voice your Needs


•   Grow with Gratitude

•   Surrender to Spiritual Practices

•   Unconditionally Love

•    Zealfully Play