Questionnaire

Prepare for your smoking cessation session in just a few minutes.

Information

About the Questionnaire

In order to offer you 100% personalized support, we invite you to fill out this short confidential questionnaire. Your answers will allow us to better understand your relationship with tobacco and adapt your session as best as possible.

Your data will remain strictly confidential and will never be shared.

Questionnaire

Please Fill Out the Questionnaire

Prénom et Nom :
Environnement de Vie :
Avez-vous peur de grossir ? De rechuter ? D’échouer ?
À quels moments fumez-vous le plus ?
Votre entourage fume-t-il ?
Pourquoi souhaitez-vous arrêter de fumer ?

Legal Notice

In accordance with the General Data Protection Regulation (GDPR), your answers are collected solely as part of your support within the LASER START CENTER. They are stored securely and are never transmitted to third parties. You can request the deletion of your data at any time by contacting us.
Disclaimer: The auricular reflexology sessions offered are in no way a medical procedure. They do not replace medical treatment or a prescription from a healthcare professional. It is essential to always follow the recommendations of your doctor or pharmacist. This site provides general information on an approach related to complementary and alternative medicine and does not, under any circumstances, provide personalized advice or consultations. The practitioners listed on this site are not medical doctors and do not replace medical care in any way. By using this site, you acknowledge that it does not offer diagnosis or treatment of illnesses.
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