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Specifications Manufactured By: Cornell & Diehl Country of Manufacture: United States Blend Type: Aromatic Contents: Virginia, Cavendish Flavoring: Maple Cut: Coarse Cut Packaging: Can/Tin Net Weight: 2 oz

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The form can be a single page and should include: Their name Date of the session Their age Their date of birth Their complete contact details You also need to know: If there is any history of illness in the family Their doctors name and contact details Whether or not you can contact their doctor if necessary If their doctor or dentist has recommended they give up smoking Somewhere on the form (possibly on the back) you need them to answer the following types of questions: How long have you smoked