How many cigarettes do you smoke per day?

1/10

How long have you been smoking?

2/10

Have you tried to quit smoking before?

3/10

What is your main reason for wanting to quit?

4/10

How confident are you about quitting?

5/10

Do you have any physical symptoms when you try to quit?

6/10

Do you have a support system to help you quit?

7/10

Have you considered using nicotine replacement therapy?

8/10

How do you feel about the idea of seeking professional help?

9/10

On a scale of 1-10, how motivated are you to quit?

10/10