For more information and/or to receive a Quit Smoking Kit please fill out this online form. A Tobacco Prevention Program staff member will contact you. Please Note: This is a free toolkit with tips and information to assist VOLUSIA COUNTY RESIDENTS  in this quit attempt.  For classes and /  or free nicotine replacement, or if you do not live in Volusia County,  you must contact the Florida Quitline.

First Name:

Last Name:

Address Street 1:

Address Street 2:

City:

Zip Code:

Daytime Phone:

Email Address:

Have you contacted the Florida Tobacco Quit-For-Life Line
@ 1-877-U-CAN-NOW (1-877-822-6669) ?
Yes     No  

Comments:

To ensure this response is being sent by a person and not a computer, please enter the number you see below in the box next to the number.

By submitting this form, I certify that I am 18 years of age or older.

Please Note: The Volusia County Health Department does not dispense Nicotine Replacement Therapy, NRT’s (patches, gum, lozenges) but these services can be accessed thru the Florida Quitline.