Habit Design® Pay-Per-Habit™ Calculator
Thank you for your interest in Habit Design®: the fastest way to create new habits, backed by NIH, and money-back guaranteed! Our clinically proven method has helped over 100,000 clients create over 1 million new lasting habits.

A key reason for our success has been our ability to apply best practices from the thousands of clients that have come before you, using proprietary artificial intelligence techniques. This calculator applies that insight to derive which clinical approach is best for you and your situation. This allows us to calculate an estimated price range for your training with the highest likelihood of success.

For example: Some past clients were able to create new daily walking habits for as little as $1 a day.

Please carefully and honestly complete this diagnostic survey below. It does neither of us any good if you try to make yourself "look good"; trying to game the diagnostic doesn't work and just leads to suggestions that will not best serve you in the end.

Your individual responses to this diagnostic will be kept strictly confidential. Our clinical staff will review your responses and provide you with your personalized coaching & pricing options during your free consulting call.


Our individual client coaching is currently only available to U.S. domestic clients in the following timezones: Pacific, Mountain, Central, and Eastern. If you are a company/organization outside the U.S. and want group-based coaching, email admin@habitdesign.com and we will followup with you directly.

If you are a professional working in healthcare, wellness/wellbeing, or productivity do NOT complete this form. Contact us directly at admin@habitdesign.com and we'll followup with you directly.

Thank you!

©2022 Habit Design, Inc. All Rights Reserved.

Email *
Section 1: Background
What is your full name? *
Note: Completing this will also serve as your provided e-signature upon completion of this diagnostic survey.
What is your mobile number? *
Please use this format: "###-###-####"
What is your preferred gender identification? *
Where do you live (city/town and state)? *
e.g., "Seattle, WA". If you are in the process of moving, please indicate where you will be living during the 12-week term of your potential coaching (assuming you begin on a date of your own choosing).
Which timezone do you live in? *
If you are in the process of moving, please indicate which timezone you will be living in during the 12-week term of your potential coaching (assuming you begin on a date of your own choosing). Currently, these are the only timezones we support for individual clients (Domestic U.S.). Organizational clients (who wish to enroll multiple individuals) outside these time zones can apply for our organizational training which may provide them custom support; contact admin@habitdesign.com for more details.
What is your age range? *
Which of these best describes you? *
What is the highest level of formal education you have completed? *
If you are intending to submit a certificate of completion of this program to a professional accreditation association, please indicate which one(s) they are below.
Otherwise, if you have no intention of doing so, just skip this question.
Who is your employer? *
We ask this to see if your employer may have already subsidized a group discount, allowing you to enroll at a lower rate. Again, your response is kept strictly confidential. If you are self-employed, please still indicate the name of your business.
If you were provided a group discount code, please enter it below.
If your company or division has already contracted a negotiated group discount with us, they would have given you this code to use here.
Which of these best describes your typical physiological context while at work (or school) on weekdays? *
What specific make & model of smartphone do you currently use daily? *
e.g., "iPhone 12 Pro Max", "Samsung Galaxy S22", "Google Pixel 6 Pro", etc.
What is the most advanced level of experience you ever achieved in either a performing art (e.g., music, drama, dance, etc.) or athletics? *
No experience at all in either
Professional or Coaching level in either or both
To what degree do you agree with this statement : "I find comfort in regularity" *
Completely Disagree
Completely Agree
On a scale of 1-6, do you feel you are generally a "night owl" or a "morning person"? *
"Night owl: I am most energized late at night"
"Morning person: I am most energized early in the morning"
On a scale of 1-6, how well-rested do you feel on weekday mornings right after you wake up? *
Extremely poorly-rested
Extremely well-rested
How quick of a learner do you believe you are? *
"Not quick at all, it takes me a long time to learn new things."
"I'm a very fast learner, I pick things up very quickly."
How "detail oriented" are you? *
"Not detail oriented at all, I tend to focus on the forest"
"Extremely detail oriented, I tend to focus on small details"
How strong is your "working memory" typically? Working memory is your short term memory, the ability to remember information over a short period of time. *
"Horrible: It takes me forever to memorize something"
"Excellent: I can memorize things immediately"
To what degree to you agree with this statement: "I often find it difficult to focus my attention on what I'm doing; I am easily distracted or disengaged." *
"Completely Agree: I am very easily distracted"
"Completely Disagree: I am extremely focused"
How disciplined do you believe you are currently? *
"I can't, or won't, adhere to policies I set for myself"
"I always adhere to policies I set for myself"
At which point on this 1-6 scale do you feel you generally are in your approach to taking on new resolutions or goals? *
"No pain, no gain"
"Slow and steady wins the race"
Over the past year, have you engaged in or sought professional psychotherapy, psychiatry, counseling, or any other kind of professional of mental healthcare? *
Again, your response to this question and the entire diagnostic survey will be kept strictly confidential.
If you answered "Yes" to the previous question, please describe what you are hoping this coaching program will accomplish for you that past (or current) psychological or mental healthcare has not achieved for you thus far?
If you answered "No" to the previous question, just skip this question
What degree of familiarity do you have with Behavior Change Psychology and/or habit formation research? IMPORTANT: Read the scale below CAREFULLY as it has switched polarities. *
"Extremely familiar with either or both: I would consider myself an expert"
"Not at all familiar with either: Consider me a complete neophyte"
If you answered either a "1" or "2" to the previous question, please list any sources or concepts you'd consider to be most helpful to your previous attempts at behavior change or habit formation?
Do you currently have any business relationship (e.g., trainer, affiliate, employee, part-time employee, contractor, advisor, etc.) with any behavior change, habit training/coaching, or wellbeing company that could be considered pursuing similar objectives to Habit Design? Be honest! If so, please list them below. If not, indicate "N/A". *
Listing any entities below won't necessarily disqualify you from the program, but we don't want you to have a conflict of interest.
On a scale of 1-6, how coachable do you believe you are now (e.g., willing and eager to follow the precise instructions and advice of a teacher)? *
"I dislike following instructions and prefer doing things my way."
"I trust my teacher as the expert and always try to do what (s)he says even if I may be skeptical."
Do you currently live with a spouse, partner, or close friend you think would be highly supportive of your training and willing to assist you if necessary with easy, small supportive tasks (e.g., taking on a daily chore you used to be responsible for, positive support, etc.)? *
Imagine you're a habitual smoker who spends $2,230/year on smoking (about the average for smokers). If you instead spent the same amount on a program that successfully led you to quit smoking, on a scale of 1-6, how much of a "value" do you think you earned from the program? *
"No value whatsoever, not worth it at all"
"Awesome value, completely worth it"
Clear form
Never submit passwords through Google Forms.
This form was created inside of habitdesign.com.