Do you have an allergy (hypersensitivity) to Champix (varenicline tartrate)?
Are you breast feeding or pregnant or possibly pregnant?
Do you suffer from any of the following?
Are you taking any of the following medications?
Do you understand that when starting Champix treatment you should start with a 2 week starter pack?
Are you aware Champix increases your chances of quitting smoking but you will also need willpower to succeed (help from family and friends will also help)?
Do you understand that you should start taking Champix 1-2 weeks before you stop smoking?
Do you understand that you must stop taking Champix and contact your GP or other urgent healthcare provider if you experience any of the following conditions?
Do you agree to the following?