State of Tennessee

Success Story Submission Form: Tobacco Cessation

Thank you for sharing your tobacco cessation success story with us! Please answer the following questions and a WFHTN team member will get back to you (unless you choose to remain anonymous). With permission, some success stories may be filmed.

Please complete the photo waiver form if you choose to submit a photo(s) with your success story: https://stateoftennessee.formstack.com/forms/wfhtn_photo_release_waiver

Would you like to hear about successes from other state employees? Go here: https://www.tn.gov/wfhtn/success-stories.html

Name

First Name

Last Name

Email

(You can choose to remain anonymous)

What department are you with?*

If you selected 'Other', please let us know your agency:*

Tell us about the healthy changes you’ve made. What results have you seen because of these changes? *

What inspired you to make those changes?*

How many years did you smoke or use tobacco products? *

What resources, if any, did you use to quit? *

How do you stay motivated to stay tobacco-free? *

Have you participated in any of your agency's Wellness Council challenges or events? If so, which ones?*

What’s your favorite part of your agency’s Wellness Council challenges or events?*

What obstacles did you face during your journey and how did you tackle them? *

What’s your advice for others?*

What have you learned about yourself during this journey?*

Submit your photo(s) here.

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