Quitting Smoking Contract

    

I, {Name}, hereby vow to quit smoking as of today, {Date}.

I am doing this for my health as well as the health of my family, friends and those who live near me.

I will get rid of all of the cigarettes, cigars, pipes and paraphernalia in my house, vehicle(s) and work areas in order to remove the temptation to smoke.

I understand that I will experience withdrawal symptoms such as cravings, irritability, sleeplessness and frustration. If these symptoms or cravings get unbearable to the point that I cannot deal with them myself, I will contact one of the following people:

- {Friend Name}, {Phone Number}, {Address}

- {Friend Name}, {Phone Number}, {Address}

- {Family Name}, {Phone Number}, {Address}

- {Family Name}, {Phone Number}, {Address}

- Support Line: {Phone Number}

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Signature Date

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Witness Date

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