Weekly Self-Discipline Survey Form
Reflect on your weekly habits, routines, and self-discipline. Please answer all questions honestly to help track your personal growth.
How consistent were you in following your planned routines this week?
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1
2
3
4
5
How often did you achieve your main weekly goals?
*
1
2
3
4
5
Which area challenged your self-discipline the most this week?
*
Time management
Healthy habits
Focus and avoiding distractions
Procrastination
Other
How would you rate your ability to avoid distractions this week?
*
1
2
3
4
5
How satisfied are you with your progress on your weekly priorities?
*
1
2
3
4
5
How many days this week did you stick to your planned routines?
*
Please Select
0 days
1-2 days
3-4 days
5-6 days
7 days
Please rate your self-discipline in the following areas this week:
*
Rows
Not at all
Somewhat
Mostly
Completely
Morning routine
1
2
3
4
Healthy eating
5
6
7
8
Exercise
9
10
11
12
Time management
13
14
15
16
What was your biggest self-discipline win this week?
What is one habit you want to improve next week?
Any additional comments or reflections on your self-discipline this week?
Submit Survey
Should be Empty: