Habit Loop Questionnaire
Name
First Name
Last Name
1. What is your cornerstone habit – the one you need to focus all your attention?
2. Have you identified the cue or even cues for that habit? If so describe them.
3. Once you’ve identified the cue for the habit you want to break, have you thought about an alternate routine you can implement? You might need to try more than one, list 3 new routines you can implement.
4. What is the reward for your new routine? You’ll need to think carefully about this and make sure it’s worth repeating.
5. Remember, to drive a new habit into your life, the reward needs to develop into a craving, can you describe your craving?
6. What are the new routines you have managed to insert into your day and week to improve your health and quality of life so far? Even simple things like putting the phone down at night, getting to bed 30 mins earlier…getting up 30 mins earlier, can trigger so many benefits.
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