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
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