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Smoking Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Do you smoke?
Select if you are a smoker or non-smoker
Yes
No
2
Rate your smoking habit on a scale of 1 to 10
Rate your smoking habit using a star rating from 1 to 10
3
How many cigarettes do you smoke per day?
Please provide the number of cigarettes you smoke daily
4
Have you tried quitting smoking before?
Select if you have attempted to quit smoking in the past
Yes
No
5
What motivates you to smoke?
Share your reasons for smoking
6
Do you smoke indoors?
Select if you smoke inside buildings or enclosed spaces
Yes
No
7
How long have you been smoking?
Provide the duration of your smoking habit
8
Are you aware of the health risks associated with smoking?
Select if you are knowledgeable about the health risks of smoking
Yes
No
9
Do you smoke more when you're stressed?
Choose if stress influences your smoking habit
Yes
No
10
Would you be interested in quitting smoking?
Indicate if you are open to quitting smoking in the future
Yes
No
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