Nicotine Assessment Test - To assess the level of dependency of Nicotine/Cigarettes This is a professional assessment test used by healthcare practitioners to assess the intensity of physical addiction to nicotine/cigarettes. It contains six items that evaluate the quantity of cigarette consumption, the compulsion to use, and dependence. It's in your benefit to be honest while filing the form so that we can provide you with a fair evaluation.. Enter your age*How soon after you wake up do you smoke your first cigarette?*After 60 minute31-60 minutes6-30 minutesWithin 5 minutesOtherDo you find it difficult to refrain from smoking in places where it is forbidden?*NoYesWhich cigarette would you hate most to give up?*The first in the morningAny otherHow many cigarettes per day do you smoke?*10 or less11 to 2021 to 3031 or moreDo you smoke more frequently during the first hours after awakening than during the rest of the day?*NoYesDo you smoke even if you are so ill that you are in bed most of the day?NoYesEmail* Test results will be sent over this email address. Please provide a working email id.Phone*Name* First Last EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.