Register for the Quit Companion

Let's Get Started

Registering for the Quit Companion is quick and easy. First, you will be asked some basic questions to begin creating your account. Next, you can select a target Quit Day. Then, you will have the option of setting up your mobile phone to receive Quit Companion messages. Finally, fill out the optional information to help us better understand who is benefitting from this website.

Step 1 of 4 - Set Up Your Account (Required)

Enter your account information in the spaces provided.
Items marked with an asterisk (*) are required.

First Name*:

Last Name*:

Email Address*:

Password*:

Verify Password*:

Screen Name*:

Vice:

Packs per day?

Step 2 of 4 - Set Your Quit Day

Quit Day is the day you decide in advance you will quit smoking for good. Some people like to choose a day with special meaning to them, like a birthday, anniversary, or holiday. Others will simply choose a day at random. In any case, when you mark the day on your calendar and commit to quitting at that time, you commit to never smoking again.

I'm not ready to quit yet.

Your quit date: August 1, 2010

Step 3 of 4 - Set Up Your Text Messaging Feature (Optional)

The Quit Companion enables you to use SMS (or Short Message Service) to send text messages to your mobile phone or hand-held device†. To enable this option in your Quit Companion account, enter your mobile phone number and select your provider below. While there is no charge to use our service, your carrier may charge you standard text message rates.

Mobile Number:
(ex: 123-456-7890)

Mobile Provider:

Step 4 of 4 - Additional Details (Optional)

You can further customize your Quit Companion account by entering the additional details requested below.

County:

Sex: Male Female

Age:

Race:

How long have you been smoking?

How many times have you tried quitting smoking?:

How did you hear about DeterminedToQuit.com?:

If other, please specify:

Smoking Fact

Women who stop smoking before pregnancy or within the first 3 to 4 months of pregnancy will reduce their risk of having a low birth weight baby to that of women who never smoked.