byegwaai free assessment

Free Smoking Assessment

Howzit 👋

Before we get cracking with your free smoking assessment, we just need to explain a few things so that our lawyers don't throttle us for being too keen to help you get started with quitting smoking.

This free assessment makes an algorithmically generated report of your smoking habits (reviewed by our doctors) and then emailed through to you. It is purely information and educational and is not intended to be medical advice. If you would like in-depth guidance through quitting smoking, we suggest you consider signing up for our 10-week quitting program, in which a doctor will be assigned to you and will provide you with a personalised treatment plan to conquer your habit once and for all.

By completing this assessment you agree to our Privacy Policy and Terms & Conditions which can be found at the foot of the page.
Name*

First NameLast Name
Sign here*

Clear

Personal Details

Please fill in your details below.
Gender*
Phone Number
Cell Number*
Please enter your 10-digit South African Cell Number
Date of Birth*

DayMonthYear
E-mail Address*
example@example.com
Have you previously completed a ByeGwaai program?*

YesNo
If Yes, when did you complete the program? What happened thereafter?

Thank you for completing your free smoking assessment!

Click Submit Form to complete your assessment. You will receive an email within 24 hours with your report attached. Please keep an eye on your spam folders, as sometimes our emails get lost in there!
Should be Empty: