USPHS-Rx for Change Tobacco Free Pledge*
*Tobacco use for sacred/religious purposes is excluded

By entering your name at the bottom of this pledge, you are pledging the following:

I promise not to smoke or use any commercial tobacco products now and forever. In addition, I will always try to stay away from secondhand smoke, which is a danger to my health.

I understand that tobacco in any form is harmful to my health and the health of those around me. Thus, I will encourage people who do smoke or use tobacco products to quit smoking and using tobacco products. I will support tobacco users as they try to quit. I will use the information learned from this training program to refer tobacco users to appropriate tobacco cessation resources.

I promise that by taking this tobacco cessation training program, provided by the United States Public Health Service, that I pledge to refrain from future tobacco use.

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* 1. First Name

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* 2. Last Name

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* 3. City