Sierra Center for Peak Perfromance

PERSONALIZED
HEALTH
 &
 WELLNESS 
 AFFIRMATIONS

STEP I:
PERSONALIZED ASSESSMENT

Please use this form to set goals and action steps and Dr. Relax will turn your goals and action steps into powerful affirmations and mental rehearsals that will motivate, inspire and reinforce your efforts to reach your goals. 

To take the first step in the development of a personalized training program that is specific to you, your health goals and your unique circumstances, simply complete this form and click on "Send" at the bottom. 

You will receive a confirmation of your successful submission or an error message that will tell you what you missed. If you receive the error message just hit "Back" in your browser, correct the error and hit "Submit" again at the bottom of the page.

If you are not sure how these affirmations can help you see: http://www.drrelax.com/ezine1.htm#3

What is your first name?
What is your last name?
What is your gender?
What is your age?
What are your process goals for improved health & wellness? Give at least 4 Goals.

Process: To walk five miles each day.

Avoid Outcome goals: To become more fit.

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What must you do to achieve each of the goals stated above? (What actions must you take?)* Note that Step 1 is the action you must take to achieve Goal 1 and each step should be paired with each goal above. 1.
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What is the single biggest challenge to you reaching your goals?
Are there any circumstances that are a particular challenge to your efforts at reaching your goals?
What feelings or emotions do you associate with reaching your goals?
(Try to name more than four if you can.)		 1.
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What specifically do you believe my training will help you to do
better with regard to health & wellness?
Name three people you admire 1.
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