STEP 2 - CAN YOU TELL US A LITTLE MORE?

WE REALLY WANT TO TAILOR OUR SUPPORT FOR YOUR INDIVIDUAL NEEDS. YOU CAN HELP US BY TELLING US MORE ABOUT THE FOLLOWING:

    1

    Do you smoke, vape or use some other sort of nicotine substance? Please choose from the options below

    2

    How often do you smoke, vape or use a nicotine substance?




    Times or less

    PER DAY

    3

    What is it costing you weekly?

    £

    £

    OR LESS

    (£)PER WEEK

    4

    What are your main reasons for stopping?

    If 'OTHER' please tell us a little more below:

    5

    Have you tried to seek help before ?

    YESNO

    If YES please give details here

    6

    What would it feel like to be free of this smoking trap?

    7

    About You


    8

    Your Contact Details



     

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