Stop Smoking Survey | Stop Smoking Tip

Our Survey

Trying to quit smoking? Take our confidential survey. Your answers and valuable feedback will help us learn more about how we can help in the quitting process and provide better support for smokers who want to quit.
We do not collect any private data. All fields, including your info, are totally optional.
Thank you for your help.

1. How long have you been smoking?
Less than 5 years
More than 5 years
More than 10 years
More than 20 years

2. How many cigarettes per day do you smoke (approximately)?
Less than 1/2 pack a day
1 pack a day
2 packs a day
More than 2 packs a day

3. What are your main motivations to smoke?
Pleasure
Addiction to Nicotine
Weight Loss
Relaxation

4. What are the major reasons for you to start thinking about Quitting Smoking?
Health Concerns
Friends/Relatives
Financial Reason
Smoking became socially unacceptable for you

5. How many times have you seriously tried to Quit Smoking before?
0
1
2-10
More than 10

6. What were your Primary Stop Smoking Methods?
Nicotine Products (patches, gums, etc.)
Cold Turkey without products
Hypnotherapy
Prescription medication
Laser Therapy
Acupuncture

7. Have you ever tried hypnotherapy to quit smoking?
Yes
No

8. From your previous stop smoking attempts, what experience you would like to share with other smokers who are trying to quit?

9. Do you believe it is possible for you to Stop Smoking?
Yes
No

10. From your perspective, please select main Benefits of giving up smoking.
I will feel more healthy
I will be less short of breath
I will reduce the risk of serious illness from lung cancer, heart disease and bronchitis
I will reduce chest pains, coughs, catarrh and chest infections
I will save money
I will be fitter and enjoy sport and exercise more
I will stop needing to always have cigarettes available
I will make it less likely that my children will start to smoke
I will no longer smell of tobacco
My teeth and fingers will no longer be stained by nicotine
I will reduce the damage and give my baby the best start in life, if I am pregnant
I will improve my self-respect

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