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CONGRATULATIONS!

Submitted Aug 7, 2003 Updated Apr 25, 2005
By Ray Foster, rf@mt-rushmore.net

SUMMARY

WHAT YOU LEARNED IN FIVE DAYS

Your body is designed to keep you in good health if you follow the simple but important rules you have learned these last five days. Each facet is important to help you stay free from nicotine and maintain a healthy lifestyle.

In summary:

1. "I Choose Not to Smoke."

2. Deep rhythmic breathing.

3. Six to eight glasses of water daily.

4. Cold mitten friction.

5. Exercise at least three to five days a week.

6. Adequate rest, sleep and relaxation.

7. A balanced diet, cutting down the fat, sugar and cholesterol.

8. Avoid overeating.

9. Avoid alcohol, tea and coffee.

l0. Start a new hobby or a new interest.

ll. Think of all the benefits of not smoking.

l2. Medical science confirms that people with a faith in a Higher Power live

longer. They are less apt to go back to smoking. They are the most successful

in coping with everyday living. -

(Waingrow, National Clearing House on Smoking and Health, 1971.)

HELP US HELP OTHERS - WE NEED YOUR FEEDBACK

It would help us know of your experience with this online 5 day stop smoking plan by filling out the form below and emailing it to us. THANKS

INFORMATION EVALUATION SHEET OF FIVE-DAY PLAN (THE ANSWERS TO THESE QUESTIONS ARE TO BE USED IN A STATISTICAL RESEARCH STUDY. YOUR ANSWERS WILL HELP SOMEONE ELSE TO GIVE UP CIGARETTES.)

email: ask questions or send us your feedback

Response Form

We welcome your remarks and feedback about your experience in stopping smoking and this web site. Please fill in the form and push the "Input Comments" button below.
Doctor Foster, M.D.

1. Date of enrollment:
2. City and State where you live:
3. Number of people you recruited to work with you to stop smoking:
4. Did you follow the daily program as outlined in the
"control book"(Y/N)?: 5. My age is:
6. Have you ever seriously tried to stop smoking before?(Y/N):
7. If Yes - did you stop abruptly (Y/N): or Taper off (Y/N):
8. What is the longest time you had been off tobacco?(None):
(Weeks): (months): (years):
9. Have you completely stopped smoking?(Y/N):
If No: Cut down?(Y/N):
10. What benefits have you noticed?(Less cough)(Y/N):
(Cough gone)(Y/N): (Taste improved)(Y/N):
Smell improved)(Y/N): (Sense of well being improved)(Y/N):
(other)(explain):
11. Number of years you have smoked Cigarettes: Average packs per day smoked during this time: 12. Did you refrain from using coffee during the plan?(Y/N):
13. Did you refrain from using alcohol during the plan?(Y/N):
14. What motivated you to choose to stop smoking?:

15. Why did you choose the Five-Day Plan?:

16. How did you learn of the Five-Day Plan Online?:

17. What other methods or programs have you tried?
Please name:
18. Other members of the family who smoke (mother)(Y/N):
(father)(Y/N): (sisters)(Y/N):
(brothers)(Y/N): (spouse)(Y/N): (children)(Y/N):
19. Comments about the program:
20. Your email address (optional):
THANK YOU FOR THIS IMPORTANT DATA
(optional)Name:
Org/Title:
Street Address:
City: State:
Country:
Zip Code:

Your Comments:

rf@mt-rushmore.net