HABIT CHANGING WORKSHEET:

WHAT IS YOUR RESOLUTION? ________________________________________________________________________________________________________________________________________________________________________________________________
HOW WILL YOU FEEL ONCE YOU REACH THIS GOAL? ________________________________________________________________________________________________________________________________________________________________________________________________
WHAT STAGE OF CHANGE ARE YOU IN? ________________________________________________________________________________________________________________________________
WHAT BEHAVIOR WILL HELP YOU ACHIEVE YOUR RESOLUTION? ________________________________________________________________________________________________________________________________________________________________________________________________
ARE THERE OTHER BEHAVIORS THAT WILL HELP? ________________________________________________________________________________________________________________________________________________________________________________________________
WHEN ARE YOU GOING TO START THIS NEW BEHAVIOR? ________________________________________________________________________________________________________________________________
CAN YOU USE THE SMART MODEL TO MAKE THESE BEHAVIORS MORE DETAILED? ________________________________________________________________________________________________________________________________________________________________________________________________
WHAT IS YOUR COPING ACTION PLAN? (This is your “if,then” plan) ________________________________________________________________________________________________________________________________________________________________________________________________
DO YOU HAVE A ROLE MODEL OR A SUPPORT SYSTEM? IF SO, WHO?
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IS THERE ANYTHING ELSE THAT YOU CAN THINK OF THAT WILL HELP YOU SUCCEED IN YOUR RESOLUTION? ________________________________________________________________________________________________________________________________