Week 9

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Week 9 “To Do” & Calendar

Date:

View all the videos & complete a NEW section

E.g. Safety 3 or Danger 1

Done!

Complete the Week 9 Calendar on a daily basis (See below)

Done!

Your weekly goals should ideally be completed with guidance from your Pain Truth Certified (PTC) health care provider.

COMPLETE AT THE BEGINNING OF THE WEEK

This week I will...

Do 1 NEW physical activity to get closer to my Goal #1, 2, or 3

Write here...

Done!

Do 1 NEW small household activity or errand

Write here...

Done!

Do 1 NEW small fun & enjoyable activity

Write here...

Done!

Do one relaxing & calming activity

Write here...

Done!

Do one small act of kindness to help or please someone else

Write here...

Done!

Do the activity prescribed by my PTC provider

Write here...

Done!

What can I do this week that will indicate I am moving forward?

Write here...

Done!

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What 3 small physical activities can I do today that will move me closer to my goals? Today, I did...
Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday



What 3 small pleasurable, relaxing and calming activities can I do today? Today, I savoured and enjoyed...



What am I grateful for today?

How was my sleep last night?
Great Not quite enough Hardly slept	Great Not quite enough Hardly slept	Great Not quite enough Hardly slept	Great Not quite enough Hardly slept	Great Not quite enough Hardly slept	Great Not quite enough Hardly slept	Great Not quite enough Hardly slept

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COMPLETE AT THE END OF THE WEEK

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In the past week, I have...

1. Moved closer towards my activity goals (S1)

Yes

Not Yet

2. Positively changed my relationship with pain (S2)

Yes

Not Yet

3. Done some form of daily physical activity (S3)

Yes

Not Yet

4. Experienced fun & pleasurable activities (S4)

Yes

Not Yet

5. Done some form of relaxation/calming (S5, S6)

Yes

Not Yet

6. Had fruits, vegetables & water and reduced my sugar (S7)

Yes

Not Yet

7. Experienced enjoyable social connections (S8)

Yes

Not Yet

8. Spent time outdoors (S9)

Yes

Not Yet

9. Moved towards accepting my current self (S10)

Yes

Not Yet

10. Applied good habits to improve my sleep (D6)

Yes

Not Yet

What did I do this week that indicates I am moving forward?

Write down one small activity that was either new or that you’ve slightly improved in...

When completed, either print or take a screenshot of these pages to show your PTC provider.

Your form has been submitted

Thank you %NAME% for taking the quiz/survey/feedback.
We have received your answers. You can view it anytime from this link below:
%TRACK_LINK%
We have also attached a copy of your submission.

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