register – online group program

Newfoundland and Labrador Smokers’ Helpline

1-800-363-5864

register - online group program

Register – Online Quit-Smoking Group Program

Name*
Email*
Phone Number*
Postal Code
Which of the following best describes you?
When did you quit?
MM slash DD slash YYYY
How did you hear about the NL Smokers' Helpline website?
Do you remember which website?
Do you remember which station?
Do you remember which channel?
Gender
- male
- female
Year of birth (YYYY)
Do you currently smoke cigarettes:
How many cigarettes do you smoke per day on the days that you smoke?
How soon after you wake up do you smoke your first cigarette?
How ready do you feel to quit?
- Planning to quit in the next 30 days
- Planning to quit in the next 6 months
- Not planning to quit in the next 6 months
Once registered, you will receive an email with everything you need to know to join the online group. In the meantime, if you would like additional support, the Helpline will text you once per day (weekdays, 5 texts per week) with tips and information to help you move forward with quitting.
Would you like to receive daily text messages from the Helpline?
- Yes
- No thanks
Please let us know if there is a different phone number that we should use for texts. If so, enter it below.
One of the key services of the Helpline is over-the-phone support where you can discuss strategies and your quit plan with one of our ‘quit coaches’. You’re going to get LOTS of help through the online group program, however if you would like extra one-on-one support over-the-phone then we will call you.
Would you like to receive a follow-up phone call to discuss the Smokers' Helpline services and to discuss your personal plan to quit or reduce your smoking?
- Yes
- No thanks
Please let us know if you prefer that we call at a specific time of day. For ex., let us know if it is best for us to call in the Morning, Afternoon or Evening.
When we try calling, is it okay for us to leave a message if we reach a voice mail or if someone else answers the phone?
- Yes
- No
During the past 12 months, how many times did you stop smoking/using tobacco for at least 24 hours because you were trying to quit?
To ensure we are providing the best service to our clients, an independent evaluation of our service is conducted on an ongoing basis. If you are willing to participate in this evaluation, a surveyor from Health Canada may contact you in 7 months. Your name and email and additional information you provided using this service will be used for evaluation purposes only; your name and email will be destroyed after you participate in the evaluation.
Would you like to take part in the evaluation?
- Yes
- No thanks
Captcha
Email
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