How strongly do you believe in your ability to make and sustain your health goals?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
2.
How willing are you to allow your health status to evolve gradually rather than requiring a “quick fix”?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
3.
How well do you handle
imperfections in your performance as you work towards your goals? In
other words, if you have a setback, are you able to quickly move on?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
4.
How well can you accept varying
levels of motivation as an inevitable process of change without feeling
like your efforts are going to fail whenever your motivation drops?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
5.
How strongly do you feel your health behavior is determined by you rather than by external events in life?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
6.
How easily can you allow yourself to make mistakes without getting frustrated or upset with yourself?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
7.
How content are you with
practicing healthy behavior 80% of the time (versus requiring yourself
to practice healthy behavior 100% of the time?)
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
8.
There are different stages of
readiness for taking on new tasks. How high would you rate your
readiness for change with regard to your health goals?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
9.
In the same way that one might
apply for a job and imagine oneself in this role, or look for a new
house and picture oneself living in the house, how well can you
visualize yourself living the healthy lifestyle you would like to
practice?
A. 
1
B. 
2
C. 
3
D. 
4
E. 
5
F. 
6
G. 
7
H. 
8
I. 
9
J. 
10
10.
There are always things that
compete for time in life. How big a priority is it for you to live with
healthy habits at this time in your life?
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