Smoking Habits Survey
  • Name
  • Date of birth
  • Gender
  • Occupation
  • Do you smoke?
  • What type of smoker are you?
  • How much do you smoke?
  • How much do you spend a month on smoking?
  • What cigarettes do you smoke? Check all that apply.

  • At what age did you start smoking?
  • Is there family history of smoking?

  • Please elaborate

  • Does anyone close to you smoke?

  • Please elaborate

  • Are you aware of the dangers and health problems that come from smoking?

  • Why do you smoke?

That's all, folks!

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