Smoking Cessation Questionnaire

Thank you for your interest in our holistic smoking cessation treatment, combining Aculaser and Bach Flowers therapy.

This questionnaire will allow us to know you better and assess if and how we can best help you quit smoking effectively and as comfortably as possible.

Please answer all the questions giving as much information as possible and press SUBMIT.

You will then receive a confirmation email with a copy of your filled questionnaire and Bodywave will contact you shortly after to give you an assessment based on your answers and arrange your first Smoking Cessation appointment.

Thank you for taking the time to answer this questionnaire,

You will receive an email with a copy of your answers.

Bodywave will get back to you after reviewing your answers for the next steps in your smoking cessation treatment.

Best Regards,

Cecile@Bodywave