Vaping Intake | nicolemarie444

Name

Email

What is your strongest feeling that comes up when you think about vaping?

Complete this sentence: "I am tired of vaping because..."

Do you find yourself vaping automatically without realizing you even picked it up?

Rarely

Sometimes

Often

Almost always (it feels like an extension of my hand)

When do you most often vape? (Check all that apply)

First thing in morning (before getting out of bed)

While working/at computer

While driving

In the bathroom

Social situations/friends who vape

Right before going to sleep or in the night

When stressed or anxious

When bored or doing mindless tasks (watching TV/scrolling phone)

How soon after waking do you take your first puff?

Within 5 minutes

Within 6-30 minutes

Within 31-60

After 60

What type of device do you use? How long does one pod last?

What happens when you are forced to go without your vape -flights, long meetings etc (Check all that apply)

Irritability or quick temper

Intense mental preoccupation (think about it constant)

Panic or anxiety

Brain fog/difficulty concentrating

Physical restlessness/fidgeting

No noticeable symptoms

What do you feel vaping gives you that you are afraid to lose? (e.g., escape, way to handle social anxiety, reward)

What is your biggest reason for wanting to be vape free?

What has made quitting difficult in the past?

Nicole Marie