Quitline Iowa Post Presentation Survey
Please take 3 minutes to complete the post presentation survey. This will help us to gain a better insight on how to provide comprehensive support to you in tobacco cessation work.  Upon completion of this survey you will be mailed a FREE toolkit with promotional and educational items to support your work.
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Email *
First and Last Name *
Agency Name *
Street Address *
City, State, Zip Code *
County Agency Located *
Which of the following best describes your service area? *
Does your agency or organization currently have a tobacco‐free policy (e.g. building or campus or facility)? *
Does your agency or organization currently screen clients/patients for tobacco use? *
Does your agency or organization currently refer clients/patients to Quitline Iowa, a free tobacco cessation treatment program? *
Which of the following types of education, training and technical assistance would your agency or organization would like to receive? *
Required
What barriers have you experienced in addressing tobacco cessation and prevention in your work?
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