The QuitPath program is designed to help those who want to quit smoking. Information gathered in this survey may be shared with researchers to unsure the quality of programs offered in the Yukon are meeting the needs of Yukoners. Your personal contact information is kept confidential and is required for participation in the QuitPath program; all other questions are optional.

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* Personal information:

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* You are:

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* Contact information:

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* Are you 18 or over?

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