Are you ready to quit smoking?

Step 1

Answer the questions below

When are you planning to quit?

1. How soon after you wake up do you smoke your first cigarette? *required
2. Do you find it difficult not to smoke in places where it is not allowed? *required
3. Which cigarette would you most hate to give up? *required
4. How many cigarettes per day do you smoke? *required
5. Do you smoke more during the first few hours after awakening than during the rest of the day? *required
6. Do you smoke when you are ill and in bed for most of the day? *required

1. Have you tried to quit smoking in the past? *required
a. How many times have you tried to quit? *required
b. What methods did you use to quit in the past?

c. What caused you to start smoking again?
2. Are you pregnant or breast-feeding?
3. Do you have any medical conditions? (If so, please list them.) *required

4. Are you taking any medications? (If so, please list them.) *required

This information is provided for educational information purposes only. It is not designed or intended to constitute medical advice or to be used for diagnosis or to replace your Doctor. Consult your Pharmacist or Doctor to determine the appropriateness of the information for your specific situation. Articles and Nicotine Dependency Test tool are copyright MediResource Inc. 1996 – 2018. Terms and conditions of use.