Butt Stops Here Patient Registration

Thank you for your interest in the Hudson Headwaters virtual Butt Stops Here Program!

The Hudson Headwaters virtual Butt Stops Here Program is a 6-week tobacco cessation program for our patients.

Participants will learn about nicotine addiction, nicotine replacement therapies (for example, nicotine gum, & lozenges) stress management and coping skills, shared experiences and goals. Unlike a traditional live, in-person series, this class will be run virtually so participants can log in on a smartphone, tablet or computer.

Please take a moment to register. It should only take about 2 minutes!

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* 1. Please enter your contact information below

First and Last Name

Street Address

Town/City

Zipcode

Email Address

phone number

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* 2. Please choose one of the 6 week sessions you would like to sign up for?

Every Wednesday starting on March 10 -April 14th at 12:00 pm -12:45pm

Every Wednesdays starting on March 10 - April 14th at 6:00pm- 6:45pm

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* 3. Please enter your age range:

21-30

31-40

41-50

51-60

61-70

70 and above

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* 4. How did you hear about this program?

Social Media

Healthcare Provider

Program Flyer

Other

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* 5. How ready are you to quit?

I would like to listen & learn how to quit in the future.

I am not ready today, but I want to quit soon.

I have been thinking about quitting for awhile & need support to start!

I am motivated & ready today!

I am not sure at this time, but have an open-mind.