Get the Smoke Free - Quit Smoking Now on the App Store - Apple
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Tobacco / Smoking Questionnaire
SECTION I: AGENT INFORMATION
Full Name of AgentAddress Line 1Address Line 2City, State, ZipEMailBusiness Photocell Phoneme Number NumberSECTION II: CLIENT BACKGROUND
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How to fill out smoke - quit smoking
How to fill out smoke - quit smoking
01
Set a quit date
02
Identify triggers and plan how to avoid them
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Get support from friends, family, or a support group
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Consider using nicotine replacement therapy or medications
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Stay busy to distract yourself from cravings
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Reward yourself for reaching milestones
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People who want to improve their overall health
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What is smoke - quit smoking?
Smoke - quit smoking is a program designed to help individuals quit smoking and improve their overall health.
Who is required to file smoke - quit smoking?
Individuals who smoke and wish to quit are required to participate in the smoke - quit smoking program.
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The purpose of smoke - quit smoking is to reduce the harmful effects of smoking on individuals' health and encourage them to quit smoking.
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Individuals participating in the smoke - quit smoking program must report their progress in quitting smoking and any challenges faced during the process.
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