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What a Smoking Cessation evaluation does for you.

Average time: 2 mins

1. It removes the need to answer awkward (but necessary questions) face-to-face.

2. It helps your doctor diagnose you faster which reduces their time and increases cost savings to you.

3. It is more comprehensive which enables your doctor to make a more accurate diagnosis.

By clicking on begin you have acknowledged that you have read and understood our Privacy Policy and Terms Of Use., and consent to the collection, use and disclosure of your personal data to Noah Health Pte Ltd. for the purposes set out in the Notice.

Name *

First

Last

Full name as per your NRIC or Passport

Date of birth *//

Do you smoke your first cigarette within 30 minutes *

Yes
Sometimes
No

How many cigarettes, on average, do you smoke every day? *

Fewer than 10
11-20
21-30
30+

Do you use any other forms of tobacco or nicotine? Please select all that apply. *

Cigar
Vaping (electronic or e-cigarettes)
Chewing Tobacco
Pipe
Bidis
Kreteks
Snuff
No, I don't use any other forms of tobacco or nicotine.

Do any of the following medical events or conditions currently apply to you? This information will help your doctor determine the most appropriate treatment for you. Select all that apply. *

Heart attack within the past 2 weeks
Serious or worsening chest pain
Untreated abnormal heart rhythm (arrhythmias)
Severe jaw disease
Unhealed stomach or intestinal ulcers
A history of suicidal thoughts or plans to hurt yourself
Uncontrolled depression
Uncontrolled high blood pressure
Seizures or epilepsy
Angina or chest pain with walking
Heart disease, open heart surgery, coronary arterial disease
Kidney problems
Liver problems
None apply to me

Do you have now, or have you ever been diagnosed with, any of the following conditions? Select all that apply. *

Bipolar or family history of bipolar
History of suicide attempts
Mood or mental health disorder
Depression
Schizophrenia
Anxiety
Eating disorder, bulimia, or anorexia
No, I have never had any of these conditions

Please describe your bipolar or family history of bipolar in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your history of suicide attempts in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your mood or mental health disorder in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your depression in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your Schizophrenia in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your anxiety in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Please describe your eating disorder, bulimia, or anorexia in more detail. What is your specific diagnosis? What treatments have you received in the past? What treatments are you receiving now? *

Have you ever tried to quit smoking in the past?

1-2 times
3-4 times
5-6 times
More than 6 times
No, I have never tried quitting before.

What methods have you tried in the past? *

Bupropion (Zyban, Wellbutrin)
Varenicline (Champix)
Nicotine Replacement Therapy (gum)
Counseling/Therapy
Cold Turkey
None apply to me

Did you experience any side effects with Bupropion (Zyban, Wellbutrin)? If so, what side effects did you experience? *

Did you experience any side effects with Varenicline (Champix)? If so, what side effects did you experience? *

Did you experience any side effects with Nicotine Replacement Therapy (gum) ? If so, what side effects did you experience? *

Did you experience any side effects with Counseling/Therapy? If so, what side effects did you experience? *

Did you experience any side effects with Cold Turkey? If so, what side effects did you experience? *

Halfway there!

The following questions delve deeper into your medical history. This enables our doctor to gain a clearer picture of your medical profile.

In the last 6 months, have you experienced any of the following? Select all that apply. *

Unexplained fevers
Unexplained weight loss (without trying)
Unexplained night sweats
Unexplained coughing up blood
Difficulty speaking or swallowing
Drooping of one eyelid
None apply to me

Please explain your symptoms. *

Please list all of your current medicines, vitamins, and dietary supplements. Include any medicines (e.g., Lipitor, Zyrtec, ibuprofen), herbs, vitamins, or dietary supplements that you have taken in the past 2 weeks, even if you are not taking them today. *

Do you have any allergies? Include any allergies to food, dyes, prescription or over-the-counter medicines (e.g., antibiotics, allergy medications), herbs, vitamins, supplements, or anything else.

Please describe your allergies. *

Is there anything else you want your doctor to know about your condition or health?

Based on your responses, the recommended medication is Champix. *

3 months of treatment for $450.

Smoking cessation treatment requires 3 months of commitment. Your doctor will be taking you through what you can expect each month.

Ok great! Now we need some documents for official verification.

We take every information you submit very seriously and they are only used by our doctors for diagnosis. In addition, your data is AES-256 encrypted and stored securely in our database. We also ensure encryption in transit and all traffic on Noah is SSL connection secure. Noah also complies fully with Singapore’s Personal Data Protection Act 2012.

Upload a picture of your physical NRIC, Passport or Driver's Licence. *

No PDFs. Our doctors are required by MOH to verify your identity using a government-issued ID. Your data is encrypted using an XTS-AES-256 cipher implemented on a hardware module on the instance.

Name

Smoking Cessation Evaluation

What a Smoking Cessation evaluation does for you.

Halfway there!

Ok great! Now we need some documents for official verification.

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