Quit Smoking Now!
REGISTER FOR STUDY!
About Ellen Barner
To qualify for the study, please answer the following:
How many cigarettes do you smoke a day ?
place the average number in the box
What is your age?
Less than 18
Have you quit for at least once for 1 week or more?
Are you on medication for anxiety and/or depression?
Are you on medication to quit smoking?
Yes, right now
No, not now
Have taken in past
Examples: 1. nicotine replacement therapy Nicoderm, Nicotrol or other brand of nicotine (oral, transdermal or nasal spray) 2. bupropion (Wellbutrin, Zyban) 3. varenicline (Chantix) 4. clonidine (Catapres) 5. nortriptyline (Pamelor)
Have you been diagnosed with a mental or personality disorder (i.e., anxiety or depression)?
In the past
Choose the best answer
Do you wish to quit smoking?
Put first and last name in box.
Type your City and State in the box.
Just place 5 digit zip code in box
Your Phone Number
The best number to reach you
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