Stop Smoking - Calculator

Part One

How old are you?          Male Female

How old were you when you started smoking?  

Who is this for? Me  Friend/Family

Over the past month (30 days) how many of those days did you smoke?   

How many cigarettes do you smoke a day?

How many of you friends smoke? None  Very few Some Most All

Does anyone you live with smoke?  Yes No

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Quit Smoking Program
Quit Smoking
and Lose Weight!
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Learn About
the Effects
of Smoking