Life Assessment Planner

ADVANCED
PLANNING

SELF
ASSESSMENT

©Michele Duncan King



This Paperwork Belongs To:

(Full Legal Name)

Advance Planning
Self Assessment

ASSESS SPECIFIC AREAS OF YOUR LIFE

On this page, assess your understanding of preparing for end of
life in each of the following areas.

On a scale from 1 to 5, shade the bars accordingly depending
on your preparedness.

Comfort Death Care Family & Pets Finances

Health Organization Personal Legacy Spiritual Life

WWW.MICHELEDUNCANKING.COM

Life Review

WHAT DO YOU FEEL NEEDS TO BE COMPLETED?

For a deeper analysis, write down a short statement for each of the
areas in part 1. How fulfilled and satisfied do you feel about each of

them.

Emotional Domain: Mental Domain:
Honoring Feelings and Healing Personal Meaning, Purpose, and

Relationships Legacy

Physical Domain: Spiritual Domain:
Health, Environment, Comfort Care, Honoring Personal Beliefs and

Death Care Practices, Community

START THE MAP

ACTION ITEMS

Choose two areas you'd like to work on over the next few months. List
any actions you need to achieve your goals.

Goals Actions

Goals Actions

Practical Matters
PRACTICAL MATTERS

NOTES AND THOUGHTS

Achievements

Reminders

Additional Notes

Advance Planning Coach | End-of-Life Doula
©Michele Duncan King