"*" indicates required fields

Rate how frequently and how well you do each of the categories below.

Social Self Care

How FREQUENTLY do you do the following?

I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often
I rarely do thisI sometimes do thisI do this oftenI'd like to do this more often

How WELL do you do the following?

I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
I don't do this wellI'm OK at doing thisI do this wellI'd like to be most improved at this
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