Information Package – Repeat

Quit Smoking Forms and Audios

Since you started smoking again, you will need to do further preparation for this session. While you have filled in the forms previously, you will need to fill them them in again.

Lives can change and you may have different reasons why you want to quit.  This will include the Ideas to Replace Cigarettes. Highlight the ones you can relate to on this form and also add additional ideas.

The other form which is very important is the 3 Day Action Plan.

There are a  number of forms to fill in and and they are listed below. These are fillable forms. So click the link of each one and fill it in. Email them back to

These need to be filled in and returned two days before your session. If you need assistance call Nicole on 3261 3557 who will be able to guide you with this.

Confidential Information

Fill this in and email it back to

Confidential Personal Information Form


Times You Smoke and Reasons For Quitting

Fill this in email it back to

Times-and-Reasons new


Ideas To Replace Cigarette Smoking

Fill this in email it back to

Ideas to replace cigarette smoking new


Pre-Session Action Plan

Please read this document before your appointment, making sure you follow the links it contains. Keep it for later reference.

Pre Session Action Plan


DASS21 Assessment Form

People often use cigarettes as a crutch for them. Letting the cigarettes go can cause a release of emotional challenges. So it is important we capture those areas and are aware of them prior to quitting smoking so they can be addressed.

DASS21 new


3 Day Action Plan

This form is in preparation for you becoming a non smoker. You need to fill this form in for 3 days before you come in for your Quit Smoking session. It will give you time to think of what you can be doing instead of smoking. For example what are you going to do when you are bored instead of smoking.

Every cigarette you smoke you will fill in this form. The purpose of this is to let your unconscious mind know that you really are over the smoking and want to stop. Filling in this form is important.

NOTE: You will not need this form after your Quit Smoking session as you will be a non smoker. This is only for preparation.

3 Day Action Plan new

NOTE:- Now that you have filled in all the forms, email them to


Listen to these two Audios

The first one is  an introduction to hypnosis that is fun and informative. You can listen to the first track in the car or when you are driving to work.

The second one is an actual stress relief self-hypnosis and this second audio will require you to be in a quiet space where you can relax and enjoy the experience of hypnosis, certainly not driving a car or using any machinery. It is a good idea to listen to them well before your session.

Please ensure you also listen to it the night before your session and have a good night’s sleep.

Listen to the two audios on the website

The address is 91 Kyeema Cres Bald Hills.

Maureen will look forward to seeing you again and assisting with restarting your non-smoking journey.