My Personal Quit Smoking Plan
My quit date is: ________________ My quit method is: ____________________________________
My main reason for wanting to become a nonsmoker is: ____________________________________
Positive things I can tell myself to help me become a nonsmoker (affirmations):
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________
Ways I can become aware of my smoking habit:
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________
Some negative thoughts or actions that may get in the way of sticking to my plan:
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________
Changes I will make before my quit date (preparations):
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________
Things I can do to keep busy when I feel the urge to smoke:
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________
Rewards I will give myself along the way as I do the above items and when I quit:
1. __________________________________________ 2. ________________________________________
3. __________________________________________ 4. ________________________________________