This group will receive usual care.

This group will receive usual care alongside a form that helps elicit self-management goals as well as preferred treatment modalities.

The intervention will be a form, given prior to a primary care visit, that allows patients to express a self-management goal (health goal) they would like to work on, and a preferred treatment modality.

Single item measure of self rated health:

"How would you rate your overall health during the past week? (1=Very Poor, 7=Excellent)?"

We will compare scores between groups as well as change over 6-weeks between groups.

Our secondary outcome measure will include a measure of behavior specific improvements. We will evaluate both component improvements for their specified behavior, as well as the composite score of negative health behaviors assessed from a series of questions.