register- SHL website – Smokers Helpline

Please choose the reason you would like to access this site
Occupation*
Other:
Name*
First Last
Phone*
Phone Ext. (if applicable)
Workplace/Health Institution*
Region*
Unit/Program

If referring from Hospital, please specify
Username*

Please choose a username which will be visible in Chat Forums/Message Boards on this site.
Email*

We will protect your privacy and your email address will not be shared with anyone.
Create a password to log-in to this site.*
Enter Password Confirm Password
The Helpline is pleased to provide you with feedback reports/updates several times per year regarding best practices in the area of tobacco cessation. How would you prefer to receive communications from the Smokers' Helpline?
- Email
- Fax
Fax

We ask some questions about your smoking history to help us personalize the information we'll deliver to you. Please let us know more about where you are currently at in the process of quitting.
Which of the following best describes you?
When did you quit?
MM slash DD slash YYYY
How many cigarettes do you smoke per day on the days you smoke?
How ready do you feel to quit smoking?

There are a variety of ways the Smokers' Helpline can deliver helpful information to help boost your motivation and readiness to quit smoking tobacco.
Would you like to receive inspirational text messages on the topic of mindfulness and quitting smoking?
You will receive 1 text per day during the weekdays (5 texts per week).
Text Messages
- yes
- no
Would you like to receive emails on the topic of mindfulness and quitting smoking?
You will receive 1 email per week for 5 weeks.
Emails
- yes
- no

Based on the selections you indicated, we'll ask you for your contact information so we can deliver your requested programs. This information is protected by the NL Smokers' Helpline and will not be shared or sold to any outside agencies.
Phone Number for texts, including area code
*only for residents of Newfoundland and Labrador, Canada
Would you like a follow-up phone call from one of our 'quit coaches' to further discuss your progress and ways that you can integrate mindfulness into your quit plan? This is an excellent opportunity to ask any questions you may have and to get some extra support. We can also let you know about other Smokers' Helpline services available.
Phone
- yes
- no
Phone Number for phone calls, including area code)
When we try calling, is it okay for us to leave a message if someone else answers the phone or if we reach a voice mail?
- Yes
- No thanks
What is the best time for us to try calling?
- Morning
- Afternoon
- Evening
- Anytime

There are a few quick demographic questions which are asked for statistical purposes. This lets us know if we are reaching people of different ages, from different areas of the province, etc. We'd like to remind you again that everything you share with the NL Smokers' Helpline is confidential.
Gender
- male
- female
- other
- prefer not to answer
Year of birth (YYYY)
What is your postal code?*

If you have any specific questions, or if there is any other information you'd like to share with our quit coaches about your quit-smoking journey, then please feel free to write us a message below.
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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