MyQuit smoking assessment
Why do I smoke?
{The reasons I smoke::3:}
Why do I want to quit?
{The reasons I want to quit::5:}
What are my concerns about quitting?
{Select any concerns that apply::7}
Other concern:
{Other concern:8}
How many cigarettes do I usually smoke per day?
{How many cigarettes do you usually smoke per day?:10}
If you don’t smoke daily – how many do you smoke per month?
{If you don’t smoke daily – how many do you smoke per month?:11}
How soon after I wake up do I smoke my first cigarette?
{How soon after you wake up do you smoke your first cigarette?:13}
Your 24 hour smoking habits
{Your 24 hour smoking habits:14:}
What triggers you?
{Select any triggers that apply::16}
Other trigger:
{Other trigger:17}
Select the support options that you think might interest you:
{Select the support options that you think might interest you::19}
Which medications am I interested in using?
{Which medications are you interested in using?:21}
How you would like to quit?
{Select below which way you think would work best for you::23}
My quit day:
{Select your quit day:25}
