PCH Consulting and Training Lifestyle Change Questionnaire
Climb by Patricia Charles-Heathers

Life strategies for:

Health & financial strategies

Organizational strategies


Lifestyle Change Questionnaire

At this time, you may have already gathered some information regarding who we are and what services we offer. We now invite you to spend a few minutes completing our brief and confidential 20-item questionnaire. The purpose of this questionnaire is to give you and us an indication of how you currently feel about your life, and how you make and manage decisions that involve change.

This is not a test; therefore there are no wrong or right answers. Simply select the response that best describes how you feel about each statement.


Your first name or your initials (optional):
Strongly
Agree
Agree
Not
Sure
Disagree
Strongly
Disagree
1. I am ready to make the lifestyle changes that will improve my well-being.
2. I find it hard to stick with tasks that require me to change my habits.
3. I am concerned about the course my life will take if I do not make lifestyle changes now.
4. I am committed to working on my goals until I get the results that I expect.
5. I believe that making lifestyle changes involve adopting long-term rather than temporary behaviors.

© 2008 PCH Consulting and Training Specialists