Stop Smoking Quizby adminApril 13, 2014Uncategorized0 %Stop Smoking Success Quiz% %How motivated are you to stop smoking and likely to succeed?% Name Email On the scale below, how ready do you feel you are to stop smoking right now? Extremely Ready Somewhat Ready Thinking about it some Not at all Since you first started smoking cigarettes how many serious attempts to quit smoking have you made that lasted longer than 24 hours? More than 10 5-10 1-5 Never tried to quit How willing are you to have an open mind and try new ideas and things? Not willing at all Moderately willing My mind is open Have you been told by a doctor that you have any health concerns related to smoking(heart and circulation conditions, respiratory conditions, cancer, digestive, angina, etc.)? Yes No Do you hide your smoking from family or friends? Yes No On the below scale, how much do you experience feelings of social exclusion, or being an outcast because of your smoking? Very often At times Never How addicted do you feel you are to nicotine? Very addicted Somewhat Not at all Do you know someone who has quit cold turkey before? Yes No Has someone related to you died from a smoke related disease? Yes No Are you open to new ideas and suggestions? Yes Some what No Do you believe people can make changes easily? Yes No Do you believe you can successfully stop smoking with the right help? Yes No Has anyone ever been able to convince you of a different perspective on a topic? Yes No Do you feel you are always right about things or have a hard time seeing things from a different perspective? Which below, best describes you? Yes I am usually right. At times I can admit I am wrong No, I often see other peoples view on things. I will have support from friends and family in my life if I choose to quit smoking? Yes I think so No Can you imagine living your life as a non-smoker? Yes, clearly At times I can imagine it Not really Other than yourself does anyone smoke in your presence at home or at work? Yes, at home Yes, at work Yes, both No I use or can see how I could use other things rather than smoking to calm myself down in stressful situations? Yes Maybe No On the below scale, how much do you experience low energy because of smoking? Very much Some Not at all Do you feel you are a rebel at heart? Yes Some No Are you concerned with weight gain when you stop smoking? Not at all Some Very concerned During the past 3 months how many days did you not smoke any cigarettes? None One Two Three More than Three Are you aware of and/or feel embarrassed or ashamed of smelling of smoke? No At times Yes, often How long have you smoked? How many cigarettes/packs do you smoke per day? How long have you smoked? Is there anything else you would like me to know about your smoking habit? Enter your text here %POINT_SCORE% Time's up %Stop Smoking Success Quiz% %How motivated are you to stop smoking and likely to succeed?% Name Email On the scale below, how ready do you feel you are to stop smoking right now? Extremely Ready Somewhat Ready Thinking about it some Not at all Since you first started smoking cigarettes how many serious attempts to quit smoking have you made that lasted longer than 24 hours? More than 10 5-10 1-5 Never tried to quit How willing are you to have an open mind and try new ideas and things? Not willing at all Moderately willing My mind is open Have you been told by a doctor that you have any health concerns related to smoking(heart and circulation conditions, respiratory conditions, cancer, digestive, angina, etc.)? Yes No Do you hide your smoking from family or friends? Yes No On the below scale, how much do you experience feelings of social exclusion, or being an outcast because of your smoking? Very often At times Never How addicted do you feel you are to nicotine? Very addicted Somewhat Not at all Do you know someone who has quit cold turkey before? Yes No Has someone related to you died from a smoke related disease? Yes No Are you open to new ideas and suggestions? Yes Some what No Do you believe people can make changes easily? Yes No Do you believe you can successfully stop smoking with the right help? Yes No Has anyone ever been able to convince you of a different perspective on a topic? Yes No Do you feel you are always right about things or have a hard time seeing things from a different perspective? Which below, best describes you? Yes I am usually right. At times I can admit I am wrong No, I often see other peoples view on things. I will have support from friends and family in my life if I choose to quit smoking? Yes I think so No Can you imagine living your life as a non-smoker? Yes, clearly At times I can imagine it Not really Other than yourself does anyone smoke in your presence at home or at work? Yes, at home Yes, at work Yes, both No I use or can see how I could use other things rather than smoking to calm myself down in stressful situations? Yes Maybe No On the below scale, how much do you experience low energy because of smoking? Very much Some Not at all Do you feel you are a rebel at heart? Yes Some No Are you concerned with weight gain when you stop smoking? Not at all Some Very concerned During the past 3 months how many days did you not smoke any cigarettes? None One Two Three More than Three Are you aware of and/or feel embarrassed or ashamed of smelling of smoke? No At times Yes, often How long have you smoked? How many cigarettes/packs do you smoke per day? How long have you smoked? Is there anything else you would like me to know about your smoking habit? Enter your text here %POINT_SCORE% Time's up. 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