Tobacco Cessation Program Interest Survey
Tarrant County Public Health's Tobacco Cessation Program is 4 sessions, meeting once a week for 4 weeks, and is an hour in length.
Please complete the brief survey that follows to allow us to better serve you.
1.
What is your first and last name?
2.
What is your zip code?
3.
What is your e-mail address?
4.
What is your cell phone number?
5.
How did you hear about the Tobacco Cessation Program?
6.
Please select which program format is preferred?
Virtual
In-person
Either Virtual or In-person
7.
What day of the week is best for you? (select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
8.
What time of day is best for you? (select all that apply)
mid-morning (10am)
lunch time (12pm)
mid-afternoon (2pm)
early evening (6pm)
