The Quit Smoking Program Form Template by WPForms is perfect for health organizations, community centers, and wellness bloggers looking for a way to onboard clients who want to quit smoking altogether.
How Does the Quit Smoking Program Form Template Work?
The Quit Smoking Program Form Template requires the WPForms Pro License and the Signature Addon to collect information from clients regarding their smoking habits and acquire their consent for future treatments. Fields include:
- Personal Information:
- Full Name: Collect the participant’s name to foster a personal connection and future correspondence.
- Gender: Gender-specific data can aid in tailoring the quit-smoking advice more effectively.
- Email Address: Essential for sending program updates and support materials to the client.
- Date of Birth: Helps in understanding the age demographics of participants to tailor plans accordingly.
- Phone Number: A direct line for urgent communications or motivational support when required.
- Smoking History:
- Age when you started smoking: This insight assists in assessing the depth of the smoking habit.
- Number of years you have smoked: Understanding the duration can help tailor the quitting strategy.
- Average number of cigarettes smoked per day: Gauges the intensity of the smoking habit.
- Previous attempts to quit (if any): Insights into past attempts can guide the customization of support.
- Triggers for smoking (select all that apply): Identifying triggers is crucial for developing coping strategies.
- Quit Plan:
- Reason for wanting to quit: Motivational insights can strengthen the support framework.
- Set a Quit Date: Setting a tangible goal for participants to work towards can help make them feel motivated.
- Preferred methods for quitting (select all that apply): Tailors the program to suit individual preferences and needs.
- Consent to participate in the program and follow the quit plan: Ensures participants understand the program’s framework.
- Signature and Date: A formal acknowledgment of commitment to the program, enabled by the Signature Addon.
Sign up with WPForms today and access the Quit Smoking Program Form Template to encourage people to quite smoking, manage entries, track progress, and maintain engagement through targeted communications.
