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The Dentist Self Care & Burnout Assessment
You're burnt out, Doc. This assessment will help you figure out which areas of your life are causing you to feel burnt out and will be helpful in creating a customized action plan for you.
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* Gibt eine erforderliche Frage an
E-Mail-Adresse
*
Ihre E-Mail-Adresse
How many years have you been in practice?
< 5 years
5-10 years
10-20 years
20+ years
Sonstiges:
Describe your current practice/work situation
associate dentist
own a practice
in residency
work at dental school
Sonstiges:
How many days do you practice?
1
2
3
4
5
6
7
Sonstiges:
Do you consider yourself burnt out?
Yes
No
Maybe
Sonstiges:
Auswahl löschen
After a typical day I feel (mark all that apply)
Stressed
Exhausted
Happy
Energized
Unsure of myself
Not too tired
Neutral
Sonstiges:
I look forward to going to work.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
During the time I've been a dentist, my body feels increasingly more strained/fatigued after performing dental work.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I don't feel stressed on a daily basis.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
Self-doubts don't hold me back in my work or personal life.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I feel in control of my life.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I enjoy performing clinical dentistry.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I enjoy managing my practice (if applicable).
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I experience and create much joy in my life.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
If money weren't an object, I'd still practice dentistry.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I am getting enough sleep.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
The quality of my sleep is good.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I have an exercise regimen that I try my best to stick with.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
There are things I want to be doing but am not doing for my own self care.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I am doing the best I can in terms of self care.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Auswahl löschen
I want to lose weight
Yes
No
Sonstiges:
Auswahl löschen
In what ways do you think you can improve your daily self care? (Check all that apply and list anything else that comes to mind)
Make healthier food choices
Improve sleep (quantity and/or quality)
Prioritize exercise
Drink more water
Process stress more productively
Sonstiges:
What things bring you joy? List whatever comes to your mind.
Meine Antwort
Describe your ideal life, including whatever elements you'd like (work, love life, health, finances, spiritual, etc). There's no right or wrong! Feel free to write whatever you want, it doesn't matter how unrealistic any of it might sound!
Meine Antwort
What are your biggest obstacles to taking care of yourself more consistently? (Check all that apply and elaborate if needed)
Practice situation isn't the way you want it
Marriage or personal relationships aren't the way you want it
Don't believe you can make the necessary changes
Are afraid of making other people upset by voicing your needs
You have physical limitations
Other people's needs come first
Feeling stuck
Too many responsabilities
Sonstiges:
How motivated are you to make changes in your life?
Not Motivated
1
2
3
4
5
Super Motivated
Auswahl löschen
Have you ever worked with or considered working with a coach to help you make these changes?
Yes
No
Sonstiges:
Auswahl löschen
Would you like to receive emails specifically geared to help dentists (like you) reduce burnout, take better care of yourself, AND increase enjoyment of your life?
There is zero spam and you can unsubscribe whenever.
Yes please!
Not now thanks
Auswahl löschen
Would you like Dr. Natanya to reach out to you to analyze your test results and create a customized self care and anti-burnout plan?
Yes please!
Not now thanks
Auswahl löschen
Sie erhalten unter der von Ihnen angegebenen E-Mail-Adresse eine Kopie Ihrer Antworten.
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