No Smoking Contract
Contract to Quit Tobacco
The Contract to Quit Tobacco is a way to help you commit to your goal of quitting and staying tobacco-free. It is a short form you complete and sign in front of a witness, who could be a family member or close friend. By signing the form, you promise to quit smoking or using smokeless tobacco starting at a certain date, and to notify the witness if you relapse at any time.
The No Smoking Contract can be found on the American Heart Association Web Site.
A PDF Version of the No Smoking Contract is also available.
Smokeless tobacco is a known cause of mouth cancer, pancreatic cancer, leukoplakia (white sores in the mouth that can lead to cancer), receding gums and bone loss around the roots of the teeth.