Description
“I’d rather smoke than gain weight.” It is said flatly, and it usually ends the conversation. This set is what you hand over instead.
For clinicians, coaches and quit advisors
Plenty of worksheets let you print and use them with clients. This one does too. Here is what it adds.
- You may give a client their own blank copy to keep, by email or through a secure patient portal.
- You may use it in groups you run yourself.
- You may print without limit, for as long as you practice.
- And a written license page comes as a separate sheet in the download, so your practice has something to file.
One practitioner. Not transferable to a colleague, and not for resale.
Written for smoking cessation
Not adapted from general therapy material, and not adapted from diet material either. Every page was built for the client who would rather keep smoking than watch the scale move — by a nurse with twenty-five years in pulmonary care who is also a certified quit coach.
Why appetite, and not willpower
Most people who quit expect the cravings. Fewer are warned that their appetite will change, that food will start tasting different, and that the scale may move. For some clients that is the thing that ends the quit — not the nicotine.
The belief underneath it is usually one sentence: that a number on the scale means the quit was not worth it. As long as it stays unspoken, it wins. These pages explain what is actually happening, separate real hunger from a cue, and put that one belief on paper where it can be tested.
What you get
Five pages — US Letter and A4 both included — 171 fillable fields.
Plus the license page, in both sizes.
1 — The Science of Appetite & Weight
What changes after quitting and why: appetite, taste, resting energy use, and the routine moments that turn into eating moments. Two columns on what a scale can and cannot show. Eight signals to check off, and room to write what the client notices.
2 — The Hand-to-Mouth Swap Plan
Four signals, five responses each. The client picks three go-to swaps in advance, so they are not deciding in the moment.
3 — The Cognitive Weight Ledger
A full cognitive behavioral thought record: the moment, the automatic thought with a belief rating, what has actually happened in two columns, the chosen answer with a second rating, and the line they carry into the next time.
4 — The Hunger, Appetite & Craving Check
Body clues on one side, cue clues on the other, and one chosen path. Urge rated before and after.
5 — The Fourteen-Day Signal Log
The strongest signal of the day, what the client chose instead, urge from 1 to 5, smoke-free yes or no. Fourteen days is long enough to see a pattern and short enough to finish.
How it sits in a session
Page 1 is the handout. It carries the explanation in plain language and can be read at home before the appointment, so the session does not start with the biology.
Page 2 is done in advance, with you or alone: the three swaps are chosen while nothing is happening, not in the kitchen at ten at night.
Page 3 is homework. The client brings you two ratings, before and after, which gives you a number to open the next appointment with instead of an impression.
Page 4 is the in-the-moment page and can be handed out on its own.
Page 5 gives you fourteen days on one sheet. That is the page to look at together.
What this set does not do: no calorie targets, no goal weights, no meal plans, no food lists, and no daily weigh-in column. The log records the signal and the response, deliberately not the body. Page 3 carries a scale boundary the client sets themselves, including no weighing for now, and a line pointing to a qualified professional if body-image or eating concerns feel overwhelming.
Nothing on these pages asks for a diagnosis, and nothing is scored.
Three ways to use it
- Hand a client one page, or all five.
- They type straight into it on a phone or tablet — page 4 is needed where the cue is, not at a printer.
- Or print it and use a pen.
Two sizes, both fillable
US Letter, 8.5 x 11 in — United States and Canada
A4, 210 x 297 mm — the standard size everywhere else
Both are in the download at no extra cost, and both work the same way: type on screen, or print. The fields do not show on paper.
Before you start
Open the file in Adobe Acrobat Reader — it’s free, on iPhone, Android, Mac and Windows. A browser preview will show the pages, but it won’t reliably keep what a client types.
Keep the blank original blank. Save filled copies under a new name.
The practice license
One practitioner, unlimited clients, worldwide. Print for your own clients, use one-to-one and in groups you run yourself, send a blank copy to an individual client, and keep a filled copy in a client file where your recordkeeping rules require it. Not for resale, and not transferable to a colleague — each practitioner needs their own. The full terms come as a separate page in the download.
Personalized license copy, on request
The license page carries the name of this set and has fields for your name, your practice, and the date of purchase, so you can complete it yourself and keep it with your records. If you would rather have those details typeset into the page instead of typed into a form field, write to hello@cessationworksheets.com after your purchase and I will send one back. No charge — it is part of the license.
How buying works
Checkout runs through Gumroad, a payment platform used by independent creators worldwide. You pay on their secure checkout page, and your card details never reach me.
The price shown here is $7.99 before tax. VAT or sales tax is added at checkout, based on where you live, so the total can differ from country to country. You see the full amount before you pay.
Charges are processed in US dollars. Outside the United States, your bank converts the amount and may add a small fee of its own.
Straight after payment you get a download link on screen and by email, with both files — A4 and US Letter — and a receipt.
Who wrote this
I am a pulmonary nurse, trained in asthma and COPD. I work in a respiratory outpatient clinic, where I see people with asthma and COPD and run the smoking cessation consultations. I am listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is built on national standards for tobacco dependence and on published evidence, and checked against the guidance in each. See the seven guidelines.
No lectures. No scare tactics.
Instant digital download. Nothing is shipped. No refunds once the download has been opened. If the file does not work as described, write to me and I will sort it out.
Support tool only — not medical or nutrition advice, and not a substitute for the clinical judgment of the practitioner using it.