Document text
Name: [FULL NAME]
My quit date: [DATE]
Cigarettes a day now: [NUMBER] · Price of a pack: $[AMOUNT] · Cigarettes in a pack: [NUMBER]
Why I am quitting
1. [MY FIRST REASON — e.g. MY CHILDREN, MY HEALTH, MONEY]
2. [MY SECOND REASON]
3. [MY THIRD REASON]
Money I will save
Period Saved
A week $[AMOUNT]
A month $[AMOUNT]
A year $[AMOUNT]
5 years $[AMOUNT]
What I will do with it: [MY SAVINGS GOAL]
My triggers and what I will do instead
When I usually smoke What I will do instead
[E.G. WITH MORNING COFFEE] [E.G. A WALK, WATER, CHEWING GUM]
[E.G. ON BREAKS AT WORK] [WHAT I WILL DO]
[E.G. WHEN STRESSED] [WHAT I WILL DO]
[E.G. WITH FRIENDS, WITH A DRINK] [WHAT I WILL DO]
Before my quit date
☐ Throw away cigarettes, lighters and ashtrays at home, in the car and at work
☐ Tell family, friends and co-workers my date
☐ Ask one person to be my supporter
☐ Save the quitline number in my phone
☐ Ask my doctor about help to quit, before using any medicine
Health milestones (World Health Organization)
From my quit date What happens
Within 20 minutes Heart rate and blood pressure drop
12 hours Carbon monoxide in the blood drops to normal
2–12 weeks Circulation improves and lung function increases
1–9 months Coughing and shortness of breath decrease
1 year Risk of coronary heart disease is about half that of a smoker
5–15 years Stroke risk falls to that of a non-smoker
10 years Lung cancer risk falls to about half that of a smoker
15 years Risk of coronary heart disease is that of a non-smoker
Where I will call for help
Quitline: 1-800-QUIT-NOW (1-800-784-8669) — free coaching · Spanish: 1-855-DÉJELO-YA (1-855-335-3569)
My supporter: [NAME] · [PHONE]
My doctor or clinic: [NAME] · [PHONE]
Days smoke-free
Week Mon Tue Wed Thu Fri Sat Sun
1 ☐ ☐ ☐ ☐ ☐ ☐ ☐
2 ☐ ☐ ☐ ☐ ☐ ☐ ☐
3 ☐ ☐ ☐ ☐ ☐ ☐ ☐
4 ☐ ☐ ☐ ☐ ☐ ☐ ☐
Signatures
I choose this date and these reasons myself.
Signature: ____________________ Date: [DATE]
Supporter: [NAME] ____________________ Date: [DATE]
This plan does not replace a doctor. Ask a doctor before using any quit-smoking medicine.
Reply to this document or get a deadline reminder: https://layers.md/us/quit-smoking-money-saved-calculator?from=reply-us-quit-smoking