American Indian (MN)

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.

Tobacco plays an important role for many tribes for ceremonial and spiritual purposes. Some American Indian people use tobacco for spiritual or cultural reasons and others do not.
This program respects the individual relationship to the tobacco plant and allows further examination of the cultural aspects of that relationship, as desired.
This program honors all parts of the medicine wheel and believes to promote wellness, one needs harmony between mind, body and spirit. We are here to assist individuals in finding this balance and harmony.

Are you interested in enrolling in this special program?

What best describes your gender?

Tobacco impacts gender differently. Answering this will help us provide you the most accurate information.

Male

Female

Transgender female/Trans woman

Transgender male/Trans man

Genderqueer/Gender nonconforming

Other

In which program would you like to participate?

Online only - This program provides educational materials, quit planning, and quit progress tracking through our website. Phone + Online- This program provides coaching over the phone, plus technology-based support including email, text, chat and web-based educational materials and quit progress tracking through our website.

Online Only

Phone + Online

Include a minimum of 8 characters, with at least 1 of each of the following: uppercase & lowercase characters, digits, and non-alphabetic characters (e.G. @, $, !, %, *, #, ?, ., &)

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