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YES To Life
If you're willing to quit tobacco, we are here to help!
Together, let's conquer tobacco and say YES to life.
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Gender
*
Female
Male
Other:
Age (in years)
*
Below 10
Between 10 - 20
Between 21 - 30
Between 31 - 40
Between 41 - 50
Above 50
City
*
Your answer
What, according to you, influences one to take up tobacco?
*
Tobacco commercials
Movies/ Web Series
Social Media
Family/friends/peers
Point of sale boards
Stress/boredom
Other:
Required
Have you tried to quit tobacco before?
*
Yes
No
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