Tobacco Cessation Program Follow-Up Question Title * Member Information Name Employer that offered Program Email Address Question Title * Have you been tobacco-free and nicotine-free during the last 3 months? Yes No Question Title * Have you been tobacco-free and nicotine-free during the last 6 months? Yes No Question Title * Have you been tobacco-free and nicotine-free during the last 12 months? Yes No Question Title * When was the last time you used tobacco and/or nicotine products? This includes cigarettes, dip, chew, cigars, e-ciggs, nicotine patches/lozenges, etc. Please enter the date below: Question Title * You previously participated in the Tobacco Cessation program provided by your employer sponsored wellness program. Please provide feedback about your experience with the program. Next