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About the Quitline
About the Quitline Programs
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Enroll today
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About the Quitline
About the Quitline Programs
How The Program Works
Helping Friends & Family
Program FAQs
Resources
About Quitting
Podcast
Proven Strategies for Quitting
Success Stories
Benefits of Quitting
Lung Cancer Screening
Tobacco's Health Effects
Tobacco and You
Interactive Tools
Health Professionals
Education
Make a Referral
Community Organizations
Quitline FAQs
Enroll Now
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Welcome! Begin your quit journey by selecting the programs you would like to enroll in.
Tell Us About Yourself
The following questions help us to understand you and find the right tools to help you quit using tobacco.
Medical Conditions
Medical screening questions are asked to determine if there are any potential contraindications for any or all types of quit medication recommendations.
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* Required
*
Select the free services you would like to use.
Online:
Develop a personalized quit plan and quitting tools which can include patches, gum or lozenges.
Nicotine Replacement Therapy:
Learn about and order your quit medications such as patches, gum or lozenges.
Phone:
Coaching over the phone to develop a quit plan, which can include patches, gum or lozenges.
Email:
Get motivational, informational, coaching and other types of email messages.
Next we need to collect some information to create your personalized profile.
What is your preferred language?
English
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Other Language
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Acholi
Afrikaans
Akan
Albanian
American Sign Lang
Amharic
Arabic
Arakanese
Armenian
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Assyrian
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Azeri
Bakunin
Barbara
Basque
Behdini
Belorussian
Bengali
Berber
Bosnian
Bulgarian
Burmese
Cantonese
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Chaldean
Chaochow
Chavacano
Cherokee
Chin
Chuukese
Cree
Croatian
Czech
Danish
Dari
Dinka
Diula
Dutch
English
Estonian
Ewe
Farsi (Persian)
Fijian Hindi
Finnish
Flemish
French
French Canadian
Fukienese
Fula
Fulani
Fuzhou
Ga
Gaddang
Gaelic
Georgian
German
Greek
Gujarati
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Haaka - China
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Haitian Creole
Hebrew
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Japanese
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Other
Pahari
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Patois
Pidgin English
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Romanian
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Spanish
Sudanese Arabic
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Swahili
Swedish
Sylhetti
Tagalog
Taiwanese
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Turkish
Twi
Ukrainian
Urdu
Uyghur
Uzbek
Vietnamese
Visayan
Wenzhou
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Yiddish
Yoruba
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Please enter your first name.
Please enter your last name.
What is your preferred phone number?
What Type of phone is your preferred phone?
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Cell
Home
Work
Check this box to receive coaching, motivational and other supportive messages from the Quitline. Message frequency varies. Message and data rates may apply. 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.
Do you have health insurance or workers’ compensation insurance?
Choose
Yes
No
What type of insurance do you have?
Choose
Aegis Security Ins Co
Aetna
American Medical Security
Anthem BlueCross/Blue Shield/HMO Colorado
Beech Street
Child Health Plan Plus
CICP
Cigna
Colorado Access
Community Health Plan of the Rockies
Concentra manager Care
Denver Health Medical Plan
Don't Know
Employer's Health
Health Network and Colorado Springs HealthCare Options
Humana
John Alden Life Insurance
Kaiser
Medicaid
Medicaid - Health First
Medicaid Colorado Access
Medicaid Community Health Plan of the Rockies
Medicaid Denver Health
Medicaid Kaiser
Medicaid of Rocky Mountain HMO
Medical Network of Colorado Springs
Medicare
Medicare Blue Advantage of Seniors
Medicare Kaiser Permanente Senior Advantage
Medicare Secure Horizons
Mountain Medical Affiliates
Multiplan
Mutual of Omaha
North Care
One Health Plan
Other Insurance
Pacific Life and Annuity
PacifiCare
Principal Life Insurance Company
ProActa Health Partners
Prudential HealthCare
Refused
Rocky Mountain Health Plan
Secure Horizons
SeeChange Health
Sloans Lake Health Plan
TriCare/Champus
United Healthcare
Password Criteria:
Include a minimum of 8 characters, with at least 1 of each of the following: uppercase & lowercase characters, digits, and non-alphabetic characters (e.g. !, $, #, %)
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What tobacco products 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
Are the cigarettes you usually smoke menthol cigarettes?
Yes, I usually smoke menthol cigarettes
No, I usually smoke other types of cigarettes
Don't know
Refused
Not asked
Colorado QuitLine is offering a gift card incentive for people who use menthol and complete at least 3 coaching calls. You can call 1-800-QUIT-NOW to enroll in phone coaching. We encourage you to use all five calls offered by the QuitLine to increase your chances of quitting for good.
Have you used an e-cigarette or other electronic “vaping” product in the past 30 days?
Yes
No
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
No
The Colorado Quitline welcomes:
All races
All religions
All countries of origin
All sexual orientations
All genders
All ethnicities
All abilities
We stand with you.
To serve you better and meet the needs of all participants, please consider the following optional questions.
What best describes your gender?
Male
Female
Transgender female/Trans woman
Transgender male/Trans man
Genderqueer/Gender nonconforming
Prefer to self-describe
Prefer not to answer
Are you Pregnant?
Yes
No
The Colorado Quitline 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).
I identify my ethnicity as: (Select all that apply)
American Indian or Native Alaskan
Asian
Black or African American
Hispanic or Latino/Latina
Native Hawaiian or Pacific Islander
White
Not in this list
Do you consider yourself to be gay, lesbian and/or bisexual?
Yes
No
Thanks, please indicate all of the following which apply to you:
Bisexual
Gay or lesbian
Queer
Don't know
Prefer not to answer
Do you have a promo code?
Choose
Yes
No
Promo Code:
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.
None
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
Currently pregnant
Yes
No
Due Date?
Currently breastfeeding
Yes
No
Has a healthcare provider told you not to use Nicotine Replacement Therapy, such as the patch, nicotine gum, or lozenge?
Please select one
No
Yes
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