Analyze your relapse

In analyzing the circumstances of your last relapse, you can develop strategies that will help you prevent relapses in similar circumstances, next time. This analysis is a success factor for the future.

The circumstances of your relapse :

Date of relapse:
Day of the Week:
Time:
Location:
My activity:
People present:
My mood:	other:
The reason that pushed me into lighting up a cigarette:
How to avoid picking up a cigarette in this situation the next time:
Pseudo/Name: