Can you be hypnotized to quit smoking?

Welcome to your Can you be hypnotized to quit smoking?

How long have you been smoking for?

1 year

1-5 years

5-10 years

10-20 years

20+ years

Have you ever quit smoking before?

no

yes, 1 month

yes, 6 months

yes, 1 year

yes, over 1 year

Have you used nicotine gum or patches?

no

yes

Do you currently have any of the following?

no

Scziophrenia

Bipolar

Autism

Psychopathy

Prefer not to answer

Do you normally have any activities between waking up & smoking?

no

bathroom, coffee, etc

yes, more than 3 activities

Have you ever been emotionally effected by a movie, story, etc?

almost always

often

sometimes

almost never

never

Name

Email

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