Pre-Program Assessment | The Jillian Method

25 Days of Calm Living — Pre-Program Assessment. Please use the same email again at the end of the program so your pre- and post-program responses can be matched.

First name

Email

Please think about your life as it has generally been over the past 2 weeks. For questions 1–15 use the 1–5 agreement scale.

1. I feel confident making everyday choices that support my health and well-being.

2. Taking care of my health feels manageable within my actual life.

3. I can maintain some version of my healthy routines even when I am busy, tired, stressed, or overwhelmed.

4. When I cannot follow my usual healthy routine, I can adjust it rather than giving up on it completely.

5. I can identify a smaller or easier version of a healthy behavior when I do not have the capacity to do the full version.

6. I feel confident deciding what health or wellness behavior is most useful for me on a given day.

7. Making everyday decisions about food, meals, exercise, hydration, or other health behaviors feels mentally overwhelming.

8. I feel pressure to do healthy behaviors “the right way” or perfectly.

9. If I miss a healthy behavior or routine, it is difficult for me to get back to it without feeling like I have failed.

10. I feel confident putting together a simple meal that supports my needs.

11. I can find realistic food or meal options even when I have limited time or energy.

12. I feel comfortable using shortcuts—such as frozen, canned, pre-cut, or prepared foods—when they help me take care of myself.

13. I can recognize when I need to simplify my expectations because of my current energy, stress, or circumstances.

14. I have practical strategies I can use to support myself on difficult or low-energy days.

15. Overall, healthy living feels flexible enough to fit into my life rather than requiring my life to fit around it.

21. Have you participated in a structured wellness, nutrition, lifestyle, or behavior-change program before?

Yes

No

Not sure

22. What would you most like to get from 25 Days of Calm Living?

25 Days of Calm Living – Pre-Program Assessment