Sierra Center for Peak Perfromance

FREE PERSONALIZED
WELLNESS &
WEIGHT CONTROL AFFIRMATIONS

Use this form to set goals and action steps and Dr. Relax will turn your goals and action steps into  a sample set of powerful affirmations that will motivate, inspire and reinforce your efforts to reach your Wellness and Weight Control Goals.

To ask Dr. Relax to create a free sample of personalized affirmations specific to you and your unique circumstances, simply complete this form and click on "Send" at the bottom.

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 is your target weight?
How many pounds must you lose to reach your target weight?
When do you wish to start your Weight Control program?
What are your physical exercise, process goals for weight control? Give at least 4 Goals.

Set Process: To walk five miles each day.

Avoid Outcome goals: To lose 20 pounds, for example.

(Remember that you must burn more calories than you take in to lose weight)		 1.
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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 are your nutritional/dietary goals for weight control? Give at least 4 Goals.

Process: To eat no more than 2000 calories each day.

Avoid Outcome goals: To eat less calories than I burn.

(Remember that you must burn more calories than you take in to lose weight)		 1.
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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 or times of the day when over eating tends to
occur?
Are there any foods that are a particular challenge to your efforts at weight control?
What feelings or emotions do you associate with being at your target weight?
(Try to name more than four if you can.)		 1.
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What specifically do you believe my tapes and training will help you to do
better with regard to weight control?
Name three people you admire 1.
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