11week3

Unit 3: Health Risk Assessment / Personalized Health Project

Exercise 2. Health Behavior and Modification Project Contract

Health habit or behavior I intend to change:

Current self-assessed status (refer to your current Transtheoretical Model stage of behavior):

Goal to be reached (in specific terms):

Benefits I anticipate as a result of the change:

(1)

(2)

(3)

Any benefits of not changing:

(1)

(2)

(3)

What will happen if I don't change:

Specific activities, behaviors, attitudes, or thoughts I will monitor and chart during the time period:

Target date to reach goal (when is the assignment due):

Indicators of successful achievement of my health behavior change will be:

How I will reward myself (daily, weekly, overall) for this change:

Names of project partners and times to meet to discuss progress (find a supportive friend or family member, you do not need to physically meet):

Name: Date:

Signature (type your name in a fancy font):