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I have read and understood all the information presented here. Based on this information:

I AGREE to provide information and receive emails from Leave The Pack Behind about other quit-smoking aides and/or surveys.
I AGREE to provide information. I DECLINE to receive emails from Leave The Pack Behind about other quit-smoking aides and/or surveys.
I DECLINE to provide information. This means I cannot receive free nicotine patch or gum.

NOTE: A print-friendly copy of all this information along with your PIN will appear on the screen when you submit your online survey.

Leave The Pack Behind | Brock University | 500 Glenridge Ave | St. Catharines, Ontario L2S 3A1 | P. 905 688 5550 x4992 | F. 905 984 4847

 

Smoke Free Ontario