Smoker's Helpline | Connect to Quit Smokers' Helpline
 
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Step 1 of 2 - Registration

Congratulations on making the very important decision to quit!

Please tell us a bit about yourself so we can personalize the tools that can best help you in the process of becoming smoke-free.

This should only take you about 5 minutes.


1. Do you currently smoke cigarettes?



2. When was your last cigarette? 


3. How many cigarettes do you or did you smoke on the days that you smoke?    

4. At what age did you start smoking regularly?    

5. What is your date of birth?             

6. How soon after you wake up do you or did you have your first cigarette? 




7. How many times have you tried to quit smoking where an attempt has lasted longer than 1 day?    

8. How many members of your household smoke cigarettes? 

9. You are: 


10. About how much does/did a pack of cigarettes cost you?    [Example: 6.50] 

11. How many cigarettes are in the packs you buy/bought?