This is your Member Reference Number (MRN). You’ll need to provide this when you make an appointment with an WLS counselor or contact your WLS by phone.

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Goal-Setting Worksheet

Fill out the goal-setting worksheet below. Your success depends on setting goals that really matter to you. Write down your goals, put them where you can see them, and renew them regularly.

Short-Term Goals

Write down at least two of your own personal short-term goals. What will you do over the next week or two that will help you in your life?

1.______________________________________________________________________

2.______________________________________________________________________

3.______________________________________________________________________

Long-Term Goals

Write down at least two long-term goals. Focus on where you want to be in six months, a year, or two years from now. Remember, setting goals will help you improve your life. Remember to monitor your progress and celebrate your success.

1.______________________________________________________________________

2.______________________________________________________________________

3.______________________________________________________________________

U.S. National Institutes of Health (NIH). (n.d.). Goal-setting worksheet. Retrieved June 21, 2024, from https://www.nia.nih.gov

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