My Goal & Action Plan

Goal Setting & Action Planning

Date*

Your email*

1. What is your goal?*

2. Is this goal a short, medium or long term goal?*

3. How well do you meet this goal before you begin working toward it? (0 = I don't meet it at all)*

4. What will help you reach your goal?*

5. What are you going to do?*

6. When will you do it?*

7. How often will you do it?*

8. What might get in the way of carrying out your action plan?*

9. How can this be avoided?*

10. How confident are you about completing your action plan on a scale of 0-10 (0 = not at all confident; 10 = very confident indeed)*

Tinnitus E-Programme