Scribd
Upload
23 views

Behavior Change Contract: Click On The Gray Boxes To Fill Out The Worksheet. Remember To Save Your Answers

This document contains a behavior change contract template to help set goals for changing a specific behavior within the next few months. It prompts the user to identify the behavior they want to change, their long-term goal, potential barriers and strategies to overcome them, resources that can help, and short-term goals with target dates and rewards to work towards their long-term goal. Upon achieving the long-term behavior change, the user identifies their final reward and signs the contract, with a witness.

Uploaded by

EmilySparks
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
23 views

Behavior Change Contract: Click On The Gray Boxes To Fill Out The Worksheet. Remember To Save Your Answers

This document contains a behavior change contract template to help set goals for changing a specific behavior within the next few months. It prompts the user to identify the behavior they want to change, their long-term goal, potential barriers and strategies to overcome them, resources that can help, and short-term goals with target dates and rewards to work towards their long-term goal. Upon achieving the long-term behavior change, the user identifies their final reward and signs the contract, with a witness.

Uploaded by

EmilySparks
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

Name:

Date:
Click on the gray boxes to fill out the worksheet. Remember to save your answers.
After you have completed the Self-Assessment in this chapter, select one behavior you would like to target for
change over the next few months Next, fill out the !ehavior "hange "ontract below, sign it, and either tape it to
your wall or discuss it with your health instructor as part of your work toward your long-term goal
Behavior Change Contract
1. #y behavior change will be:




2. #y long-term goal for this behavior change is:




3. !arriers that $ must overcome to make this behavior change are:
a%
b%
c%
4. &he strategies $ will use to overcome these barriers are:
a%
b%
c%
5. 'esources $ will use to help me change this behavior include:
a friend, partner, or relative:
a school-based resource:
a community-based resource:
a book or reputable website:
5. $n order to make my goal more attainable, $ have devised these short-term goals:
Short &erm goal:
&arget Date:
'eward:
Short &erm goal:
&arget Date:
'eward:
(Continued on next page)
"opyright ( )*+) ,earson -ducation $nc + of ) !ehavior "hange .orksheet
(Continued from previous page)
Short &erm goal:
&arget Date:
'eward:
.hen $ make the long-term behavior change described above, my reward will be:

&arget Date:
$ intend to make the behavior change described above $ will use the strategies and rewards above to achieve the
goals that will contribute to a healthy behavior change
Signed:
.itness:
"opyright ( )*+) ,earson -ducation $nc ) of ) !ehavior "hange .orksheet

You might also like