Congratulations!

Register for your free plan.

Filling out forms isn't anyone's idea of a good time. But by answering a few questions, you can help us help you quit smoking. So take the first step toward becoming smoke-free by registering for your free Quit Plan. Once you're finished, you'll get access to your personalized homepage, which is filled with the tools, guidance and motivation you need to kiss your cigarettes goodbye.

To start, please enter the following information.

*indicates a required field.

  • Why do you want to quit smoking? Choose all that apply.*

  • I am:
  • Are you pregnant?
    We have special info for pregnant smokers that we would like to share

  • Do you identify as Hispanic or Latino?
  • Which best represents your race or ethnicity? Choose all that apply.

  • Zip Codes must be between 2 and 10 characters in length. US zip codes should be of format XXXXX{-XXXX}.
  • ? Username already exists.
  • Password is required.
  • Passwords must match.
  • You must agree to Terms of Use to create an account.

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  • ?
  • Mobile Number must be of format XXX-XXX-XXXX.

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You're now registered for EX and are on your way to re-learning life without cigarettes and quitting smoking for good.

Before you get started, we'd like just a little more information from you. Answering these questions will help us understand who is using EX and make sure the site is as helpful as it can be.

All information will be kept private and used only to make your experience on the EX site even better (Learn more about our privacy policy here.)

1. About You

2. About Your Smoking Behavior

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1. About You

2. About Your Smoking Behavior

  • ?

  • Quit date is required and must be of format MM/DD/YYYY.

Submit

We're glad you're back. How've you been?

If you're ready to become an ex-smoker, we're ready to help you re-learn life without cigarettes.

Get started

Not sure if you're ready to quit? Not sure if EX is right for you?

Sign up to learn more about the free EX Plan.

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