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The eQuitWA Program offers regular email support that will provide you with information and strategies to help you prepare and stay quit. The program will start 2 weeks before your quit date and will continue for up to 12 weeks. If you would like to quit in less than two weeks, you can still join, however, giving yourself more time to prepare may prove helpful. Please complete the following to opt into this service:

Please complete the following and select a quit date to opt-in to this service. Those marked with an asterix [*] are required.

Email Address *


Name *

This will be used to address your emails

Password *

 

Confirm Password *

Quit Date

 

The following two questions are optional, however if completed we will use to customise the email messages and ensure they are relevant to you.

Reason for quitting

Amount spent on cigarettes a week

$

The remaining questions are again optional but will only be used in aggregate form by Quit WA.

Gender

Age

Living Arrangements

Postcode

Please note that you can Unsubscribe at anytime. Your personal details will not be disclosed to any third party. Please refer to the Terms & Conditions and the Privacy Statement.

I have read, understood and agree to be bound by the Terms and Conditions.

Please keep me informed of any new Quit WA initiatives or interesting quitting relating material.

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