STOP SMOKING QUESTIONNAIRE

Please fill out the Stop Smoking Questionnaire at least 48 hours before your first session. You may want to print out a copy for yourself. We will be discussing your answers to these questions throughout the program. You’ll also receive a copy via email. Thanks!

First thing in the morning
With coffee
After a meal
While driving
Breaks at work / home
While drinking (beer, wine, ect)
Watching TV
When bored
At the computer
On the phone
Before bed
Other….







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