Post-Cessation Follow-Up Survey
Full Name
Date of Follow-Up
Cessation Status
Have you used any tobacco or nicotine products since your quit date?
No
Yes
If yes, please describe frequency and type of use
Withdrawal & Cravings
Have you experienced any cravings or withdrawal symptoms?
No
Yes
If yes, please describe your experience
Support & Strategies
What strategies or supports have been most helpful?
Are there any challenges you are currently facing?
General Feedback
Additional comments or feedback