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Questionnaire for Smoking Cessation

Your information will be kept confidential and used only for the purpose of providing hypnosis

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What is your strongest feeling that comes up when you think about smoking?
How much does smoking affect your daily life?
When do you most smoke? (Check all that apply)
Do you find yourself smoking automatically without thinking?
How soon after waking do you smoke your first cigarette?
How many cigarettes do you smoke per day?
What happens when you try to go without smoking? (Check all that apply)
How ready are you to quit smoking?

DISCLAIMER: I, Nicole Marie, am not a medical doctor, psychiatrist, or psychologist, nor do I carry any sort of license to practice medicine.  I do not diagnose, prescribe, or provide medical treatment. All healing is self healing and voluntary. I recommend that clients continue to see their regular medical doctors and follow their advice. The work that I do does not take the place of conventional medicine or treatment for any medical or psychological condition. If you are in need of medical treatment, diagnosis, or psychological care, you should seek the proper licensed physician or healthcare professional.  My spiritual work is not for everyone, nor does it have the same results or outcome for everyone. I do not make any guarantees, warranties, or promises in regards to the results or outcome of my spiritual work.

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