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  1. Surveys
  2. 2016
  3. March
  4. S
  5. Smoking
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Questions marked with a * are required Exit Survey
 
 
Is the patient a smoker?
 
 
* If so, how many do they currently smoke in a day?
 
 
If not, are they exposed to Second Hand smoke?
 
 
 
Have they attempted to quit? What methods were used?:
   
 
 
 
Was it successful?
 
 
 
If not, are they ready to quit?
 
 
 
Would the patient be interested in smoking cession?