Q1

Test whether you are ready to stop smoking, and get your Personal ActiveStop Plan.

First name:

Age: years

Q2

How long have you smoked?

Less than 5 years
5 - 10 years
11 - 15 years
16 - 20 years
21 - 30 years
31 - 40 years
More than 40 years

Q3

How many cigarettes do you usually smoke each day?

I usually smoke around cigarettes a day.

Q4

How much do you want to give up?

I'm really keen to give up
I would quite like to give up
I'm not that bothered about giving up
I don't want to give up
Don't know

Q5

What do you dread most?

Missing the comfort and relaxation
The craving
The prospect of putting on weight

Q6

Do you think the advantages of smoking are:

Very few    1    2    3    4    5    Very many

Q7

Do you think the disadvantages of smoking are:

Very few    1    2    3    4    5    Very many

Q8

How much are you willing to put into quitting for good?

A lot
Quite a lot
A little
Nothing

Q9

Do you agree or disagree with this statement?
I think it's easier to stop when you've made a plan.

Not much    1    2    3    4    5    Much easier