Call or text to make an appointment: 970-945-8503
Quitting Smoking
A Quitting Smoking Plan:
Your current control for this condition:
Ideas for overcoming barriers:
Quit Plan and Self-monitoring:
- How motivated are you to quit (1-10):
- Current or prior cessation efforts:
- Biggest motivation to quit:
- Biggest barriers:
Ideas for overcoming barriers:
- Take my medications to help quit as prescribed ____________
- Call the Tobacco Quit line any time I feel the urge to smoke (1-800-QUIT-NOW)
- Target date to stop ___________
- Cut down and throw away any left by my quit date
- Clean carpets, blinds, and cars
- Meet with a therapist
- Call my doctor when ready to quit
- Schedule follow-up appointment
Lifestyle recommendations:
- Identify alternate activities or “good habits” to pursue in place of tobacco
- Recognize that it’s much easier to quit if friends and family quit with you
- Living with others using tobacco makes relapses more common
- Additional Health Recommendations
- Get a flu shot every Fall
- Get a pneumonia vaccine if advised by your doctor
Educational Materials: Your key to improved diabetes control!
- Go to www.glenwoodmedical.com then choose Patient Education: Tobacco
- Phone numbers:
Colorado Quit Line: 800-QUIT-NOW
Smoking Quit Line: 877-44U-QUIT
Follow up visit:
- Please see your primary care provider or a member of that care team within ___
Schedule a return visit sooner, if needed
