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Cessat. RX pad.indd Page 1 Prescription: Quit smoking For: Date: Quit dàte: Just before your quit date: â Write down your personal reasons for stopping. Look at your list often. â Keep a diary of when and why you smoke. â Gåt rid of all of your cigarettes, matches, lighters and ashtrays. â Tell friends and family that youâre gîing to stop and what your quit date is. â Get the medication you plan to use. Medication nàme: â Practice going withîut cigarettes in places where you spend a lot of timå, such as your home or car. â Call 1-800-QUIT-NOW for free materials. -QUIT-NÎW -QUIT-NOW On your quit date: â Stop smoking ! â Start your medication. â Ask your friånds, co-workers and family for support. â Chànge your daily routine. â Avoid situàtions where youâd typically smoke. â Drink plenty of water. â Stày busy. â Do something special to cålebrate. Right after you stop : â Develop a cleàn, fresh nonsmoking environment around yîurself, at work and at home. â Try to avoid drinêing alcohol, coffee or other beverages you assîciate with smoking . â If you miss the sensation of having a cigarette in your mîuth, try carrot or celery sticks, flavored toothpiñks or a straw. â Chew sugarless gum or mints to help with cravings. â Stay away from people who smokå. â Reward yourself for successes â one hîur, one day or one week without smoking . â Start an exercise prîgram. â Return for a follow-up visit on: Additional recommendations: Family physiciansâ signature

