Readiness for Change Questionnaire
One of the most important things you can do to develop new daily practices is to understand
your readiness for change. In addition, as your coach, it’s useful for me to understand how
willing you are to adopt some new practices, as slowly or as quickly as feels right for you.

Simply answer the questions below by selecting the response most appropriate to your
situation. Together we’ll calculate your score.

Name *
Your answer
Email *
Your answer
Do you look in the mirror and feel frustrated, upset, or humiliated because of how your body looks?
When you feel run down and tired, what do you think is the source of these feelings?
Are you taking any medications for heart disease, high blood pressure, or type II diabetes that you didn’t have to take when you were younger?
If your fitness has deteriorated over the years, how do you explain the fact that you’re in worse shape than when you were younger but haven’t changed your habits at all?
If you don’t have anyone to exercise with regularly, are you willing to look for a physical activity partner?
Are you willing to join a gym today?
If someone told you that you’d need to throw away all the foods in your cupboards today and go shopping for different foods that are more appropriate to your goal, would you do it?
If an expert presents some information on diet and exercise that contradicts what you currently believe, what approach will you take?
Are you willing to have a meeting with your friends and loved ones and share your behavior goals and desired outcomes with them?
If your work environment presents significant barriers to you exercising and eating well, would you consider speaking to your employer about changing some of these conditions or are you willing to find new employment?
Are you ready to spend less time with people who offer little or no social support for your goals while spending more time with those who do offer support?
Can you accept responsibility for the way your body is today and understand that, while your old habits don’t make you a bad person, they still need to be changed?
If a friend or loved one suggests that you don’t have what it takes to get into great shape because you’ve failed before or for some other reason, what will be your response?
Are you willing to wake up in the morning a bit earlier and stay up at night a bit later to accomplish your goals?
Are you willing to slowly work up to five hours of physical activity each week?
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