When you enroll in My Life, My Quit™, you will have access to free and confidential text, phone and online support.  Please complete the form to get started.
 
* Required
Yes
Do you have a history of any of the following? Check all that apply.
Yes No
Yes No
Has a healthcare provider told you not to use Nicotine Replacement Therapy, such as the patch, nicotine gum, or lozenge?

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If your state is not listed, please call 1-800-QUIT-NOW (784-8669) or visit teen.smokefree.gov to get help.