RM_Stats

RTT Freedom From Smoking Questionnaire

We can't change behavior unless we change the meaning we attach to it

These questions help me understand the beliefs you have around smoking - because that is where the work is. I want to make your hypnosis completely personal for you, and your reasons, and your beliefs so take your time and get really honest.

Email^*

First Name^*

Last Name^*

Today's Date^*

What’s the story you are telling yourself about smoking?^*

How Motivated are you to stop smoking?^*

Tell me when and why did you start smoking?^*

How long have you smoked?^*

How many times have you quit?^*

How was it when you quit? And how long did it last?^*

Why did you start again?^*

What did you think it was going to give you?^*

What was the emotion that you had, that you reached for that cigarette?^*

How many cigarettes do you smoke per day?^*

How much do you spend per week?^*

How long have you wanted to quit this time? WHY?^*

Who is the main driver behind this decision now?^*

Myself
My Partner
My Child / Children
Other

Who else has influenced the decision? (Please provide some information How)^*

How do you rate your current levels of anxiety / stress at work?^*

How do you rate your current levels of anxiety / stress personally?^*

What does smoking give you? Why do you love it?^*

What does it take away?^*

List all the reasons you found it helpful... was part of your routine, important. When is favourite time coffee, with drinks etc^*

What will be the hardest time to not smoke?^*

List all the reasons you want to quit^*

Who will you be, without smoking?^*

What are you doing to support your health now?^*

Titles

The next 2 questions are Old titles and New titles. Make a list under each of these the things you have attached to yourself, that you don't want anymore or that you want. Examples: under old title: Workaholic, busy, out of shape. New title: Healthy, vibrant, happy, content

Old Titles (things you don't want anymore)^*

New Titles (what you want)^*

What is the biggest challenge to quitting?^*

It's going to be easy or hard to quit and why? Choose one that reflects what you tell yourself.^*

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RTT Freedom From Smoking Questionnaire

Titles

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