Quit Pack

Quit Members

Welcome to The Quit Group’s order page!

Nicotine patches, gum and lozenges will help you beat cravings when you quit smoking. But please remember:

Smoking addiction has 3 parts:
Chemical – this will be helped by the patches, gum and lozenges	Habits – such as smoking with a coffee, in the car or with a drink	Emotions – do you smoke when you’re stressed? Happy?

If you want to quit successfully, it is important that you deal with all 3 parts of the addiction. So when you order your patches, you might also like to think about:

Contacting a Quitline advisor who can help you fully understand your addiction – and beat it. Call 0800 778 778 free – it could be the most important call you’ve ever made!
Signing up for Txt2Quit to get quit support on your mobile.
Browsing the rest of this site – it may just make the difference. Go to our online resources.

Order Form

Important: If you have certain medical conditions you may need to get clearance from your doctor to use nicotine patches, gum and lozenges.

Diabetics on insulin should inform their doctor of their intention to quit.

Please call the Quitline on 0800 778 778 if you:

Have had a heart attack, stroke or severe angina in the last two weeks
Are pregnant or breast feeding
Are taking medication for a mental health condition
Weigh less than 45 kilos or 7 stone.

Personal Information

Title

First Name *

Middle Name

Last Name *

Email address

Date of Birth *

Gender *

Postal (delivery) Address

Street Address *

Suburb

City *

Postcode

Phone numbers

Please specify at least one *

Home number

Mobile number

Work number

Preferred Contact Number *

Okay to leave a message? *

Smoking details

How much do you smoke? *

Tailor-made cigarettes per day

Roll your own grams per week

Pipe grams per week

Cigars per week

Time to first smoke *

How deeply do you inhale? *

You have been identified as a heavy smoker and we recommend co-therapy of patches and gum or lozenges. Please select your preference for gum or lozenges below. Patches will be issued automatically.

If you would prefer a different option for NRT than the ones offered below, please contact the Quitline on 0800 778 778.

You have been identified as a low smoker and therefore patches may not be for you. We recommend choosing gum or lozenges. Please select your preference below.

If you would prefer a different option for NRT than the ones offered below, please contact the Quitline on 0800 778 778 or click here to email us.

Which do you prefer? Patches Gum Lozenges

Research

How did you hear of this site? *

The Quit Group conducts research about the Quit Online Community and quitting. If you decide you would like to participate in our research. Information will be kept confidential.

Would you be interested in participating in future research projects about quitting online or quitting in general. *

Yes, I would like to make myself available for research.

No, I would not like to make myself available for research.

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