Join online smoking cessation study
Please answer all the questions to join this research study. Your answers are kept confidential and will not be shared with anyone except the research team.
Name
*
First Name
Last Name
Email
*
example@example.com
Age
*
Please enter your age in years.
1. Do you live in the United States?
*
Yes
No
2. Do you want to stop smoking?
*
Yes
No
3. Do you smoke every week?
*
Yes
No
4. Do you smoke on fewer than 25 days per month on average?
*
Yes
No
5. Do you have a smartphone (iPhone/Android)?
*
Yes
No
Not sure
Result
*
Pass
Fail
source
Continue
Should be Empty: