Step 1 of 2

Please tell us a bit about yourself so we can personalize the tools that can best help you. This should only take you about 5 minutes.


Are you a health care professional or a researcher? Please note that use of this program is for your personal, non-professional use.

1. What best describes your pattern of smoking? 



2. When was your last cigarette? 


3.How many cigarettes do you or did you smoke per day?   

4. How many years have you smoked?   

5. How soon after you wake up do you or did you have your first cigarette? 




6. How many times have you tried to quit in the past, and lasted 24 hours or more?   

7. How many other smokers do you live with? 

8. What's your date of birth?            

9. You are: 

10. About how much does a pack of cigarettes cost you?   [Example: 6.50] 

11. In some countries, packs contain different amounts of cigarettes. About how many cigarettes are in the packs you bought?


 
 
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This program is for educational purposes and is not to replace the advice of your family physician
or other health care provider. © 2000-2013 Evolution Health Systems Inc.
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