Our Smoking Survey
Please Print Out and Fill Out this Survey, then mail it to one of the addresses at the bottom of the page. We appreciate it. Thank You!! To fill out the survey, answer the questions and check the answers that apply to you.
Do you know anyone who smokes cigarettes? Yes__ No__
If so, about how old are they?___
Do you know anyone who has tried to quit smoking but was not successful? Yes__ No__
How times have they tried to quit? ___
What methods did they use to try and quit? _________________________________________________________
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Do you know anyone who has successfully quit smoking? Yes__ No__
What methods did they use to quit? _______________________________________________________________
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Do you know anyone who smokes cigarettes? Yes__ No__
If so, about how old are they?___
Do you know anyone who has tried to quit smoking but was not successful? Yes__ No__
How times have they tried to quit? ___
What methods did they use to try and quit? _________________________________________________________
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Do you know anyone who has successfully quit smoking? Yes__ No__
What methods did they use to quit? _______________________________________________________________
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What methods do YOU think could help people be more successful at quitting smoking?
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When You have finished the survey please send it to the following address: 411 Damian St. Vandalia OH 45377
