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Habit Renewal Assessment

1. What Are You Trying to Replace?

*

habit_choice

A

Nicotine

B

Alcohol

C

Weed

D

Porn

2.What Drives You to That Habit?

trigger_choice

A

Stress

B

Boredom

C

Anxiety

D

Social Pressure

E

Dopamine Hit (just feels good)

F

Emotional Comfort

G

Mindless Routine (habit loop)

H

Energy Boost

I

To Numb Out

3. How Does This Habit Make You Feel After?

*

Q3

A

Guilty but can't stop

B

Drained and sluggish

C

Numb

D

Brief relief, then regret

E

Totally out of control

F

Fine, but I know it's holding me back

G

Honestly... not that bad

4.What Would You Like to Feel Instead?

*

desired_outcome

A

Clear-headedness

B

Energized

C

Free from cravings

D

In control

E

Calm

F

Motivated

G

Confident

H

Connected to others

I

More present

5. What Are You Most Afraid of If You Quit?

*

5. What Are You Most Afraid of If You Quit?

A

I'll miss out on fun

B

I'll feel empty

C

I'll be bored

D

I'll have nothing to look forward to

E

I'll fail and hate myself

F

I won't feel like myself

G

Nothing, I'm just ready

6. What Small Habit Would You Actually Enjoy Replacing It With?

*

6. What Small Habit Would You Actually Enjoy Replacing It With?

A

Evening walk with music or podcast

B

Herbal tea + journaling

C

Meditation app

D

Dopamine playlist (upbeat music + dancing)

E

Cold showers

F

Reading for 10 mins

G

Stretching or light yoga

H

Creative hobby (writing, art, music)

I

Texting a friend for accountability

J

other

7. How Committed Are You to Breaking This Habit Right Now?

*

commitment level

A

10/10 – I'm ready for a total reset

B

7/10 – I'm ready, but I know I'll need support

C

5/10 – Curious, but nervous

D

3/10 – Thinking about it

E

1/10 – Not ready, just exploring

8.You’re ready — we see it. Enter your email for your next step toward freedom.

*