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Welcome! Begin your quit journey by selecting the programs you would like to enroll in.
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Nicotine Replacement Therapy:
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Next we need to collect some information to create your personalized profile.
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Tell Us About Yourself
The following questions help us to understand you and find the right tools to help you quit using tobacco.
What tobacco products have you used in the past 30 days? This does not include e-cigarettes or vaping products.
Colorado QuitLine is offering a gift card incentive for people who use menthol and complete at least 3 coaching calls. You can call 1-800-QUIT-NOW to enroll in phone coaching. We encourage you to use all five calls offered by the QuitLine to increase your chances of quitting for good.
Do you have health insurance or workers’ compensation insurance?
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Yes
No
What type of insurance do you have?
Select
Aegis Security Ins Co
Aetna
American Medical Security
Anthem BlueCross/Blue Shield/HMO Colorado
Beech Street
Child Health Plan Plus
CICP
Cigna
Colorado Access
Community Health Plan of the Rockies
Concentra manager Care
Denver Health Medical Plan
Don't Know
Employer's Health
Health Network and Colorado Springs HealthCare Options
Humana
John Alden Life Insurance
Kaiser
Medicaid
Medicaid - Health First
Medicaid Colorado Access
Medicaid Community Health Plan of the Rockies
Medicaid Denver Health
Medicaid Kaiser
Medicaid of Rocky Mountain HMO
Medical Network of Colorado Springs
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Medicare Blue Advantage of Seniors
Medicare Kaiser Permanente Senior Advantage
Medicare Secure Horizons
Mountain Medical Affiliates
Multiplan
Mutual of Omaha
North Care
One Health Plan
Other Insurance
Pacific Life and Annuity
PacifiCare
Principal Life Insurance Company
ProActa Health Partners
Prudential HealthCare
Refused
Rocky Mountain Health Plan
Secure Horizons
SeeChange Health
Sloans Lake Health Plan
Test 4
TriCare/Champus
United Healthcare
The Colorado Quitline welcomes:
All races
All religions
All countries of origin
All sexual orientations
All genders
All ethnicities
All abilities
The Colorado Quitline offers a special program just for pregnant and postpartum people. If you are currently pregnant and would like to learn more about this program or to enroll, call 1-800-QUIT-NOW (1-800-784-8669).
I identify my ethnicity as: (Select all that apply)
Thanks, please indicate all of the following which apply to you:
Do you have a promo code?
Select
Yes
No
In the last month, did you use cannabis- also known as marijuana? [if “No, Don’t Know, or Refused”, skip the rest of these questions]
Select
Yes
No
Don't know
Refused
Did you use flower or bud, concentrates like shatter or wax, edibles or another form like oils?
Flower or bud?
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Yes
No
Don't know
Refused
Concentrates like shatter or wax?
Select
Yes
No
Don't know
Refused
Edibles?
Select
Yes
No
Don't know
Refused
Other forms like oils?
Select
Yes
No
Don't know
Refused
How frequently did you use flower or bud?
Select
Most Days
About half the days
Less than half the days
Not at all
Don't know
Refused
How frequently did you use concentrates?
Select
Most Days
About half the days
Less than half the days
Not at all
Don't know
Refused
How frequently did you use edibles?
Select
Most Days
About half the days
Less than half the days
Not at all
Don't know
Refused
How frequently did you use other forms?
Select
Most Days
About half the days
Less than half the days
Not at all
Don't know
Refused
How interested are you in stopping or reducing your cannabis or marijuana use?
Select
1- Not at all
2- Slightly
3- Moderately
4- Very
5- Extremely
How interested are you in stopping or reducing your tobacco or nicotine use?
Select
1- Not at all
2- Slightly
3- Moderately
4- Very
5- Extremely
