Corporate Smoking Cessation Program- Request Form

Help us understand your company’s needs so we can prepare a tailored smoking cessation clinic for your team. A member of our team will contact you within 24–48 hours.

Company Name

Contact Person

Phone *

Email *

Location *

Number of employees *

Type of service (on-site / pop-up clinic) *

Why would you like to partner with us?

Next step?

Request a Corporate Clinic

Request a Free Consultation Call

By checking this box, I consent to receive non-marketing text messages from ANNAPOLIS VALLEY LASER THERAPY about Corporate Smoking Cessation Program. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from ANNAPOLIS VALLEY LASER THERAPY at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.