Tobacco Use Status Progress Tracker
Name
Date
Current Tobacco Use Status
Never Used
Currently Using
Former User
Attempting to Quit
Type of Tobacco Used
Cigarettes
Cigars
Pipe
Smokeless Tobacco
E-cigarette / Vape
Other
Usage Frequency (per day)
Started Using (Year)
Quit/Target Quit Date
Progress Tracker
Milestones
Date
Status Update
Comments
Additional Notes