Quins Gore Pharmacy

Quins Gore Pharmacy

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Customer Survey on Anti-Smoking Patch Treatments


The following questions relate to the way you have used Nicotine patch treatments. The aim of the survey is to determine whether the advice you received when buying the patches has helped you to give up smoking. Your answers will help identify the types of advice that have been successful and will contribute to even better ways pharmacists might assist their patients.

SECTION 1
About your smoking

For this question please RANK IN ORDER with ranking's 1 to 6, where 1 is the most important reason and 6 is the least important reason.

1. What made you decide to stop smoking?

Health reasons.. own decision	1 2 3 4 5 6
Health reasons.. Doctors request	1 2 3 4 5 6
Expense of smoking habit	1 2 3 4 5 6
Request from friends or family	1 2 3 4 5 6
No smoking policy at workplace	1 2 3 4 5 6
Other....	1 2 3 4 5 6
please specify

2. Before using nicotine patches, had you tried to give up smoking?

Yes
No (PLEASE GO TO QUESTION 8.)

3. How many previous attempts have you made?

4. Before using nicotine patches, which other methods did you use? (You may tick more than one)

Acupuncture
Hypnosis
Nicotine chewing gum
Nicobrevin
Herbal remedies
On my own without any product
Other...please specify

5. When using the methods indicated in Question 4, did you manage to stop smoking in your last attempt?

Yes
No (PLEASE GO TO QUESTION 7.)

6. In this last attempt, for how long did you stop smoking?

1 week
1 month
6 months
1 year or more

7. Why did you start smoking again?

For this question please RANK IN ORDER with ranking's 1 to 6, where 1 is the most important reason and 6 is the least important reason.

8. What made you decide to use patch treatments?

Cost	1 2 3 4 5 6
Pharmacy recommendation	1 2 3 4 5 6
Friends or other users advice	1 2 3 4 5 6
Doctors advice	1 2 3 4 5 6
Familiarity with the brand, telephone service and support kit	1 2 3 4 5 6
Advertisement	1 2 3 4 5 6


9. Before you started the patch treatments, please indicate what you smoked. Cigarettes Pipe Tobacco.. Roll your own Cigars Other...please specify 10. How many times did / do you smoke each day?(Tick one) 0-15 times a day 16-25 times a day more than 26 times a day 11. For how many years did you smoke before this attempt to stop? 12. What brand did / do you smoke? 13. did you always inhale? Always Sometimes Never 14. Did / Do you smoke more in the morning than during the rest of the day? Yes No Cannot say 15. How soon after you woke up did / do you smoke? Less than 30 minutes More than 30 minutes 16. Which smoke would / did you hate most to give up? (PLEASE STATE THE NEAREST TIME OF DAY OR ASSOCIATED EVENT, e.g. FIRST THING IN THE MORNING, or AFTER BREAKFAST, etc.) 17. Do you find it difficult to refrain from smoking in places where it is prohibited, such as in a church, cinema, theatre or library? Yes No Cannot say 18. If you were ill in bed, at home, would you still smoke? Yes No Cannot say 19. When you started the patch treatment, did you continue to smoke? Yes PLEASE GO TO QUESTION 20 No PLEASE GO TO QUESTION 23 20. For how long did you continue to smoke tobacco and wear a patch? 21. Did a pharmacist check this and advise you to stop smoking tobacco? Yes No 22. Were you aware that the patch manufacturer's insert leaflet and instructions, warned of overdosing and advised not to smoke while wearing the patch? Yes No Cannot say 23. Were you warned by a pharmacist that overdosing can occur if you continue to smoke an wear a patch? Yes No Cannot say 24. Which patch product did you use last? Nicabate Nicotinell Please enter your personal details. Name: Date of birth in: Day Month Year e-mail Phone Click Submit if you want our pharmacist to reply or Reset to clear and start again.

Quins Gore Pharmacy Ltd. will not supply of any controlled substances,
drugs of abuse or performance enhancing steroids.
We will not supply Phentermine, Redux, Meridia or any codeine based
painkillers such as Hydrocodone or Vicodin.

New Perfumes

Arthes Ladies
Arthes Mens
D'urfe Ladies
D'urfe Mens

Online Specials

Lyprinol
Imedeen
Nicorette
Evening Primrose Oil
Kervrans Silica
Zinaxin
Cica-Care Gel Sheet
Amrutanjan Balm
More . . .

Pharmacy Only

Nicabate
Nicobrevin
Telfast/Allegra
Claratyne/Claratin
Headway
More . . .

Pharmacist Only

Headway Beconase
Flixonase
Alanase
More . . .

PRESCRIPTIONS
New
Refills

Medications such as Viagra, Xenical, Celebrix, Singulair etc. are only provided on a New Zealand registered doctors prescription.
More Information..