STOP SMOKING AGREEMENT
Goal Statement: I will become an ex-smoker by _______________________ (date).
Primary Objective: I will rid myself of the idea that I get pleasure from cigarettes
I will ride myself of the idea that I need then
I will rid myself of the idea that they control me
I will own the idea that I have control over my habit
1. I agree to buy a different brand of cigarettes every morning
2. I will only buy cigarettes in the morning
3. I will set a number of cigarettes that I can smoke per day and throw the rest out each morning.
If there are any cigarettes remaining at the end of the day, I will thrown them out
4. I will not ask anyone for a cigarette.
5. I will not give a cigarette to anyone
6. I agree to replace my ashtray(s) with a glass of water
7. Each time I want a cigarette, I will take a sip of water and ask myself “Do you really want this
cigarette?” That sentence will remind me: I am about to become and EX-SMOKER.
8. I will practice the relaxation techniques and suggestions I have been taught
9. I will mark my calendars with a large “QD” Quitting Day. I feel very good about this
10.I will increase my intake of water, fruit and Vitamin C everyday to help me during this time.
Hypnotist – Sheri Ann Pochat