Wyoming - Enroll Now

Personalize Your Program

Congratulations! You're ready to get help with quitting. Please complete the form below to choose your program.

All form fields are required.

Select the services you would like to use on your quitting journey.

CREATE A QUIT PLAN:

Develop your personalized quit plan by utilizing effective tools including coaching, interactive activities, and quit medication.

TRACK MY PROGRESS:

Track how many days you've gone without tobacco. Receive check ins, motivational messages, and other support.

PHONE COACHING:

Coaching over the phone to develop a quit plan, which can include patches, gum or lozenges.

QUIT MEDICATION:

Learn about free quit medications such as gum, patches, and lozenges. We'll help you place an order.

TEXT:

Get motivational, informational, coaching and other types of text messages.

Next we need to collect some information to create your personalized profile.

What is your preferred language?

English

Spanish

Other

Other Language

What best describes your gender?

Help

Tobacco impacts gender differently. Answering this will help us provide you the most accurate information.

Male

Female

Transgender female/Trans woman

Transgender male/Trans man

Genderqueer/Gender nonconforming

Other

Are you Pregnant?

Yes

The Wyoming Quit Tobacco Program offers a special program just for pregnant and postpartum people. If you are currently pregnant and would like to learn more about this program or to enroll, call 1-800-QUIT-NOW (1-800-784-8669).

Please enter your first name.

Please enter your last name.

What is your preferred phone number?

Confirm Phone Number

What Type of phone is your preferred phone?

Check this box to receive coaching, motivational and other supportive messages from the Quitline. Message frequency varies. Message and data rates may apply. Reply HELP for help. Reply STOP to stop. For more information, please review our SMS Terms/Privacy here: https://helpline.quitlogix.org/en-US/Legal/Privacy

Please enter your zip code.

Please tell us when you were born.

Please enter your email address.

Confirm Email Address

Create Password

Passwords must include at least 8 characters with at least 1 of each of the following: uppercase letter, lowercase letter, number, and non-alphanumeric character (e.g. @, $, !, %, *, #, ?, ., &).

Confirm Password

I have read and accept the Terms / Privacy Policy

Tell Us About Yourself

We'll provide more specific resources based on the product(s) you use.

What types of tobacco have you used in the past 30 days? This does not include e-cigarettes or vaping products.

Cigarettes

Chewing tobacco, snuff, or dip

Cigars, cigarillos, or small cigars

Pipe with tobacco

Nicotine pouches such as Zyn, Rogue, or FRE

Do you smoke cigarettes every day or some days?

Every day

Some days

How many cigarettes do you smoke per day on the days that you smoke?

How soon after you wake, do you smoke your first cigarette?

Within five minutes

6 to 30 minutes

31 to 60 minutes

More than 60 minutes

Do you use chewing tobacco, snuff or dip every day or some days?

Every day

Some days

How many pouches or tins do you use per week, on the weeks that you use tobacco?

How soon after you wake, do you first use spit tobacco, snuff or chew?

Within five minutes

6 to 30 minutes

31 to 60 minutes

More than 60 minutes

Do you smoke cigars every day or some days?

Every day

Some days

How many cigars, cigarillos or little cigars do you smoke per week on the weeks that you smoke?

How soon after you wake, do you first smoke a cigar, cigarillo, or little cigar?

Within five minutes

6 to 30 minutes

31 to 60 minutes

More than 60 minutes

Do you smoke a pipe with tobacco every day or some days?

Every day

Some days

How many pipes do you smoke per week, on the weeks that you smoke?

How soon after you wake, do you first smoke a pipe?

Within five minutes

6 to 30 minutes

31 to 60 minutes

More than 60 minutes

Have you used an e-cigarette or other electronic “vaping” product in the past 30 days?

Help

E-cigarettes, vape or hookah pens are battery-operated devices that generally contain cartridges filled with nicotine, flavor and other chemicals. These turn nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user.Vaping is the act of inhaling liquid nicotine and other additives.

Yes

How many days did you use an e-cigarette or electronic “vaping” product in the last 30 days?

People use e-cigarette/e-vaping products for a variety of reasons, are you currently using e-cigarettes/e-vaping products to quit smoking?

Help

E-cigarettes, vape or hookah pens are tobacco products and not a tobacco quitting aid. Visit the proven strategies section of the website to learn about ways to quit for good.

Yes

Do you intend to completely quit using e-cigarettes/e-vaping products within the next 30 days?

Yes

Participant feedback helps us improve our services. Providing feedback is voluntary and does not impact your participation in the program. You can choose what you want to share and when you want to share it. After you complete the program, may we contact you about your experience?

Yes

What is your

medical history?

What is your

medical history?

Medical screening questions are asked to determine if there are any potential contraindications for any or all types of quit medication recommendations.

Disclaimer : We do not provide medical care. Talk to your doctor about your plan to quit tobacco and use of nicotine replacement or other quit smoking medicine if you have any questions or problems.

Read Disclaimer?

Yes

Do you have a history of any of the following? Check all that apply.

Asthma

Emphysema, Chronic Bronchitis, or COPD

History of seizures

Diabetes

Cancer

Heart disease, irregular heart rate, or angina

Heart attack within the last 12 months

Stroke within the last 12 months

High blood pressure

High blood pressure is controlled with medication

Skin condition (eczema, psoriasis, etc.) or allergies to adhesives

Use dentures or have sensitive gums

None of these apply

Currently pregnant

Yes

Due Date?

Currently breastfeeding

Yes

Has a healthcare provider told you not to use Nicotine Replacement Therapy, such as the patch, nicotine gum, or lozenge?

What is your

personal background?

What is your

personal background?

These questions are not required, but help us understand how our program is helping participants of different backgrounds.

Which of these groups would you say best describes you?

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Hispanic or Latino/Latina

Do you consider yourself to be gay, lesbian and/or bisexual?

Help

LGBT communities are disproportionately impacted by tobacco. We have information that is specific to these communities related to quitting.

Yes

Bisexual

Gay or lesbian

Queer

What is the highest level of education you have completed?

Less than grade 9

Grade 9 to 11, no degree

GED

High school degree

Some college or university (includes some technical or trade school)

College or university degree (includes AA, BA, Masters, and PH.D.)

Do you have any mental health conditions, such as an anxiety disorder, depression disorder, bipolar disorder, schizophrenia, Attention-Deficit/Hyperactivity Disorder (ADHD), Posttraumatic Stress Disorder (PTSD) or substance use disorder?

Help

Individuals with mental health conditions are disproportionately impacted by tobacco. We have information that is specific these individuals related to quitting.

Yes

Anxiety Disorder

Depression

Bipolar Disorder

Schizophrenia and Schizoaffective Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

Posttraumatic Stress Disorder (PTSD)

Substance use disorder

Other

During the past two weeks, have you experienced any emotional challenges such as excessive stress, feeling depressed or anxious?

Help

Stress, feeling depressed and feeling anxious can impact your quit journey. It’s important for us to know if you are having these feelings.

Yes

During the past two weeks, have you experienced any emotional challenges that have interfered with your work, family life, or social activities?

Help

Quitting tobacco takes time and energy. It’s important for us to know how your feelings may impact your daily activities so we can help.

Yes

Do you believe that these mental health conditions or emotional challenges will interfere with your ability to quit?

Yes

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Join Our Program At Anytime

It only takes five minutes to start a new chapter in your quitting journey

Program FAQs

Thinking about enrolling in the Quitline? Here are answers to common questions about cost, coaching and other aspects of the program.

All Program FAQs

The Quitline is free to participants. Your public health department, health plan or employer pays the program costs. If you choose to use nicotine quit medications, such as nicotine gum or patches, you may be eligible to receive 2 weeks or more for free. After that, there may be a cost for medication. When you enroll in the Quitline program, we'll help you work through these details.

You may be eligible to receive the first 2 weeks of quit medication for free. After that, you may be eligible for additional free quit medication through the Quitline based on your health plan and employer. Enroll in the program to learn more.

We offer an Online Only program with our website and other online materials. However, research shows people who use coaching are more likely to successfully quit. Completing even a few calls with a quit coach could make a difference for you. Learn more about the Quitline programs.

Enroll today—it’s easy and takes less than 5 minutes! You can enroll online, or if you'd like to speak to someone to get more information, call 1-800-QUIT-NOW. You can use the Quitline more than one time, so there is no harm in enrolling as soon as you feel ready.

Do you have a history of any of the following? Check all that apply.

1. How much does the Quitline cost?

2. How much does nicotine quit medication cost?

3. Do I need to work with a coach as part of the Quitline?

4. How do I get started with the Quitline?