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Congrats for this 1st step toward a smokefree life !
You are almost there. You only need to fill in this 2min registration form.
Step
1
of
5
20%
#1
Personal information
01. How old are you?
*
Less than 18 years old
Between 18 and 30 years old
Between 31 and 40 years old
Between 41 and 50 years old
Between 51 and 60 years old
More than 60 years old
02. What is your gender?
*
Male
Female
Non-binary
Other
03. Which canton do you live in?
*
Other
Appenzell RE
Appenzell RI
Argovie
Bâle-Campagne
Bâle-Ville
Berne
Fribourg
Genève
Glaris
Grisons
Jura
Lichsteintein
Lucerne
Neuchâtel
Nidwald
Obwald
St. Gallen
Schaffhouse
Schwyz
Solothurn
Tessin
Thurgovie
Uri
Valais
Vaud
Zug
Zurich
04. Why do you want to quit smoking?
*
Health motivations
Save money
See the positive effects on my body (skin, teeth, etc.)
External pressure (family, relatives, etc.)
Increase my sporting ability
Contribute to the protection of the environment
Other
4.1. If other, please specify :
05. Have you participated in the Month Without Tobacco in 2022?
*
Yes
No
06. How did you hear about the Month Without Tobacco program?
*
Via Instagram
Via Youtube
Via Facebook
Via Tik Tok
Via my company
Someone I know told me about it
Other
#2
Support menu
07. How would you like to receive your Month Without Tobacco practical guide (40-days agenda)?
*
By email
I do not wish to receive the Month Without Tobacco practical guide
08. Would you like to join the Month Without Tobacco online community in the Facebook group?
*
Yes
No
09. Would you like to be contacted free of charge by advisors from the Quit Smoking Helpline?
*
Yes
No
10. What is your email adress ?
*
#
Personal information
11. What is your adress ?
*
As you asked to receive the 40 days agenda in your mailbox, we need this information to send it over to you.
Street
Locality
Postal code
Name and surname
*
Consent
*
I accept that my address is shared with a third party only for sending the agenda and deleted after.
*
#
Personal information
11. What is your phone number?
*
As you asked to be contacted by the Quit Smoking Helpine, we need this information to get in contact with you.
#
Last step
Consent
*
I confirm that I wish to register for the Month Without Tobacco (and receive information by email)
*
Consent
*
I agree to the privacy policy
*
Consent
I accept to be contacted for scientific studies to support knowledge on quit smoking and future public health campaigns.
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