Emotion Regulation Goal Setting Form
Set clear, actionable goals to improve your emotion regulation with this simple, focused form.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
What is your current biggest challenge with emotion regulation?
*
Which situations or triggers most often impact your emotions?
*
Which coping strategies have you tried before?
Deep breathing
Mindfulness or meditation
Physical activity
Talking to someone
Journaling
Other
What is your primary emotion regulation goal?
*
How often do you want to work on this goal?
*
Please Select
Daily
A few times a week
Weekly
Bi-weekly
Monthly
What support or resources would help you achieve your goal?
How confident do you feel about achieving your goal?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Would you like to receive follow-up or accountability support?
*
Yes
No
Maybe later
Preferred method for follow-up (if applicable)
Email
Phone call
Text/SMS
Video call
Other
Submit
Should be Empty: