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Adult Quit Smoking/Vaping Class
Class Sign-up Form
Please fill out the sign-up form below. Once submitted, you will be contacted about start dates, locations, and any further information. If you need assistance or have questions, please call 410-632-1100 ext. 1108.
1.
First and Last Name
2.
Phone Number
3.
Best time to reach you?
Morning
Afternoon
Evening
4.
Which class location would you like to attend?
Tuesdays, 3:30 p.m. - 4:30 p.m., at the Snow Hill Health Center, (6040 Public Landing Rd.)
Wednesdays, 9:00 a.m. - 10:00 a.m., at the Pocomoke Health Center, (400-A Walnut St.)
Thursdays, 3:30 p.m. - 4:30 p.m., at the Atlantic Club, (11827 Ocean Gateway.)
Thursdays, 5:00 p.m. - 6:00 p.m., at the Gudelsky Family Medical Center, (10614 Racetrack Rd.)
Distance Learning
5.
How did you hear about this program?
social media
flyer
newspaper
WCHD Website (worcesterhealth.org)
radio
Other (please specify)
