Over-the-Phone – SHL Smokers Helpline NL 1-800-363-5864

Name*

Phone Number

When we try calling, is it okay to leave a message if another person answers or if we reach a voice mail?

Yes
No

What is the best time of day for us to call?

Morning
Afternoon
Evening
Anytime

What is your postal code?

Which of the following best describes you?

When did you quit?

How did you hear about the NL Smokers' Helpline website?

Do you remember which station?

Do you remember which channel?

Gender

male
female

Year of birth (YYYY)

Planned quit date

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?

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.

Will you allow us to share your information with the evaluators?

Yes
No

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