Smokers Questionnaire

Smokers, answer these 7 quick questions and let me help you quit smoking. Email (click email) your response and your name now. Please send your answers within the body of the email. You can even Copy and Paste this page in the email and quickly edit your answers. Do not send an email attachment.

1. Why do you want to quit smoking? (list as many reasons as you can provide)

2. Have you ever tried to quit before?
   
   • Yes
     
   • No

3. How many times have you tried to quit?
   
   • 1 time
     
   • 2 to 3 times
     
   • 4 times or more

4. What method(s) did you use in your previous attempt(s) to quit smoking (cold turkey, the patch, drugs, hypnosis, etc.)?

5. How long have you been smoking?
   
   • 1 year or less
     
   • 1 year to 2 years
     
   • 3 years to 5 years
     
   • 6 years to 10 years
     
   • 11 years to 30 years
     
   • over 30 years

6. How many packs of cigarettes a day do you smoke?
   
   • 1 pack or less a day
     
   • up to 2 packs a day
     
   • 3 packs to 5 packs a day
     
   • more than 5 packs a day

7. Have you contracted a smoking-related illness
   
   • Yes
     
   • No
   • What illness(s)

Put an end to your deadly smoking habit now. Email your answers and your name now. Take the first step to permanent smoke-freedom. Others will follow. . .

Take advantage of my personalized smoking cessation support service developed specifically for you (based on your responses), as well as, my personal evaluations and inspirational leadership for just $49 a month (email) or $79 a month (phone).

Note: Please send your answers within the body of the email. You can even Copy and Paste the questions there and quickly edit your answers. Do not send an email attachment.

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Fewer than 5 percent US adult smokers kick the habit in any given year, even though there are quitting strategies that work. But 70 percent of the 44.5 million adult smokers want to quit smoking and 40 percent make a serious quit attempt each year, according to the National Institutes of Health.

Good news! Quit smoking and watch the risk of dying in middle age quickly fall. Give yourself the chance to live longer.

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