Readiness to Change Assessment
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Email *
First Name *
Last Name *
1. I am fine where I am, I don't have any problems that need changing *
2. I might be ready for some self-improvement *
3. I have decided I will change, just not yet *
4. Some people only talk about it, but I am making changes *
5. I have changed and this feels good *
6. I don’t want to change and will change when I’m ready *
7. I enjoy [behavior] but sometimes I think it would be better to do it less *
8. I have been looking at solutions to my problem *
9. I have been cutting down on [insert a behavior] *
10. This is my 2nd or 3rd attempt, I hope I can maintain this *
11. What’s the point, I’m going to fail anyway *
12. Others have told me that I should change *
13. I need to take care of other things first before I can make this change *
14. I fell off the wagon but I’m back working on [insert a behavior] *
15. I’ve made progress but I worry I can’t keep up *
16. For some people, this may be a problem, but it does not apply to me *
17. I think I want to change, but I’m not sure what to do about it *
18. I plan on starting next week *
19. This is really hard, but I’m doing it *
20. I quit [insert a behavior] for 6 months, but I had a relapse *
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