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Breaking and Adding (new) Habits
Being a form about breaking a habit or addiction, or your quest to create a new one! Note: addiction and habit have the same connotation in this form. Entries may or not may not appear on
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* Indicates required question
Are you trying to create or break a habit?
*
Breaking a habit
Creating a new habit
Name the habit.
*
Your answer
Is this your first attempt at creating/breaking this habit?
*
Yes
No
What made you decide to break this habit/addiction?
Be as long or short as you like, but be specific about the reason(s). Please use paragraph breaks.
Your answer
What made you decide to create this habit?
Be as long or short as you like, but be specific about the reason(s). Please use paragraph breaks.
Your answer
How long since you began?
*
A week? A day? An hour? A year? Vague timeframes are fine.
MM
/
DD
/
YYYY
Does this breaking/creating a habit contribute to your life's goals?
Just throwing this out for fun
Yes
No
Other:
Clear selection
Will you give me your email address so I can contact you about your strategies and experience?
*
If not, why are you still answering this form
Your answer
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