Please help us learn a little bit about you and your current habits and your goals for this program. You will be directed to the beginning of the program at the end of this short questionnaire. 

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2. What do you hope to learn from this program? (Check all that apply)

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3. How ready are you to quit smoking or using tobacco products?

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4. How do you use tobacco products? (Check all that apply)

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8. How did you learn about this program?

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9. Do you receive your health care at a military facility?

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11. Age (number format, for example, 45).

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14. To help us anonymously track progress/results of this program, please enter the initials of your first, middle and last name. (Example: LTH)

Thank you for your time. We hope this program and information will suit your needs.

Please click the Done button to get started with developing your quit plan in the Time to Quit program.

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