Tobacco Cessation Assessments

Assessments for Smoking Cessation

In order to develop the best program for your success, we need to understand several specific things about you and your tobacco use.
  • What is your Current Level of Nicotine Dependency?

    Please complete The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. The results of this short 6 question quiz will help determine the best strategies for helping you quit, social supports, exercise programs, and so on.
  • What did Cigarettes, Smokeless Tobacco, or Cigars do for You?

    Please complete the “Why Do I Smoke?” Quiz. You were not dependent on nicotine when you started using tobacco. There were specific reasons why you started, and there are specific reasons - socially, spiritually, psychologically and physically – that you have continued to use. Understanding these reasons will help create a more effective structure and support system for staying tobacco-free.
    Please check all that apply.
  • What Obstacles may Impede your Ability to Stay Tobacco-Free?

    Please complete the Nongard Nicotine Relapse Indicator Checklist. We all have situational or emotional ‘triggers’ that can set off our urges to smoke or dip, puff, or chew. Recognizing these triggers will help us build strategies for successfully avoiding or confronting the challenges ahead.
    Please check all that apply.
  • What Activities do You Associate with Using Tobacco?

  • Why Have You Decided to Stop Smoking Now?

  • How Will You Spend Your Savings?