CMATCH- Tobacco Cessation Program Registration

CMATCH (Case Managed Approach to Tobacco Cessation Help) is a free holistic tobacco addiction recovery program that combines in-person and video sessions, with personal coaching and support to give participants the power to regain control of their lives. In-person sessions will begin in September. To learn more, visit www.livingsmart.live or contact Linda Royer, PhD, RN (540-333-2412, linda@FrameWorkHealth.org).

Name

First Name

Last Name

Phone

(###)

###

####

Do you have a non-tobacco using friend or relative who could be a support person to you in the program? (If you don't have someone we will match you with a volunteer to be your support person).

YES

Do you have access to the internet at home?

NO-

YES- By phone only

YES- By computer or tablet

CMATCH- Tobacco Cessation Program Registration

Valley Fellowship Seventh-day Adventist Church

4392 Palmyra Church Rd
Edinburg, Virginia 22824
(804) 895-4024

CMATCH- Tobacco Cessation Program Registration

Valley Fellowship Seventh-day Adventist Church

4392 Palmyra Church RdEdinburg, Virginia 22824(804) 895-4024

4392 Palmyra Church Rd
Edinburg, Virginia 22824
(804) 895-4024