Stages of Change

Path of Creating a New Habit

Precontemplation: I cannot or will not change. Or, I am not even thinking of a change.

Contemplation: I might make a change in the next 6 months or I am planning on making a change in this time frame.

Preparation: I am committed to making a change in the next 2 months.

Action: I am taking steps in making the change.

Maintenance: I have been working on the behavior for at least 6 months.

Take some time to consider the above descriptions of the stages of change. Consider your beliefs and personal intentions to begin to meditate and create a new habit in your life. Select the answer below of where you fall on the continuum of creating the habit of mindfulness and meditation.

Where do you fall on the continuum of creating the habit of mindfulness and meditation?

	Precontemplation	Contemplation	Preparation	Action	Maintenance
Stage of Change

In the space provided below, list a few measurable examples of why you selected that stage. (Example: I am in "Action" because I am listening to the audio meditations to the best of my ability and following along. Or, "Action," I completed the daily meditation and recorded my experience of the practice each day this week. Or, "Preparation," I am coming to the program, and have the intention to practice daily, and I have not made the time for the practice yet.)
Printed Name*
Date

MonthDayYear
Date
Lisa Patterson Raterman Working Mindfulness LLC 6/2020
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform