Smoking Cessation Contract

I, __________________________ herby make the promise to myself, that I will
(name)
begin my preparations to stop smoking on _________________. I will start now
(date)
to take the steps necessary to prepare myself for the Quitting Day.

The day on which I have chosen to stop smoking cigarettes is ______________.
(date)
I am stopping for the following reasons:

1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
5. ___________________________________________________________
6. ___________________________________________________________
7. ___________________________________________________________
8. ___________________________________________________________
9. ___________________________________________________________
10. ___________________________________________________________

I will remind myself of the reasons for why I have chosen to quit smoking cigarettes. Everyday, I will continue to in instill faith in my ability to meet this challenge.

Patient Signature ____________________________ Date ________________

Witness Signature_____________________________ Date ________________

Daily Contract Renewal

For the following two weeks, I ___________________ will sign below for each
(name)
day that is free of smoking cigarettes. Each time I sign my name, I will promise

to remain smoke free for another day.

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2
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7

End of Week One.
Buy something nice for yourself with the money saved in 7 days.
Congratulations!

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End of Week Two. Keep up the good work.
Congratulations!

Posted September 13th, 2006 by Abbey in articles |