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Male Patient - Stop Smoking Treatment

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For how long have you been a smoker? *

On average how many cigarettes would you smoke per day? *

Do you often find that you smoke cigarettes when consuming alcohol? *

Have you ever tried to quit smoking in the past? *

What attempts have you tried to quit smoking? *

Have you ever used Champix tablets in the past in an attempt to quit smoking? *

Who prescribed Champix tablets for you? *

Did you experience any side-effects after taking Champix tablets? *

Did you ever receive any additional outside support in an attempt to help you quit smoking? *

Are you Male or Female? *