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Personalize Your

Program

Congratulations! You're ready to get help with quitting. Please complete the form below to choose your program.
All form fields are required.
Quit Partner needs to collect some personal information to provide you with free quit nicotine services. We will also use your information to help evaluate how well our programs work and for research. The information we are collecting about you is private under Minnesota state law. Your private information will only be shared with MDH, its vendors, the Centers for Disease Control and Prevention, and other people or entities as authorized by law. If your information is shared with other external partners for program evaluation or research purposes, your name and other information that could identify you will be removed.

You will be asked some required and optional questions. You do not have to answer any of these questions, but if you do not answer the required ones, you will not be able to receive services from Quit Partner. You may be able to receive services elsewhere.
Passwords must include at least 8 characters with at least 1 of each of the following: uppercase letter, lowercase letter, number, and non-alphanumeric character (e.g. @, $, !, %, *, #, ?, ., &).
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