---
title: 211 Web Referral
image: https://kicform.org/hubfs/posst.png
---

![Kick It California Logo](https://211sj.org/wp-content/themes/yootheme/cache/71/new-kick-it-ca-1-7122e420.webp)

 Step 1 of 2

# Free Help to Quit Tobacco/Nicotine

 Get a free, personalized Quit Plan and $20 gift card when you complete a coaching call with Kick It California!

 Do you use tobacco or nicotine or want to help someone who does?*

Yes

No

 Are you 18 or older?*

Yes

No

Next

## Great! How can we reach you?

First Name*

Last Name*

Phone Number*

Email

California ZIP code*

Language English Spanish Mandarin Cantonese Korean Vietnamese

 Please confirm how we can contact you:*

A coaching call is required to create a Quit Plan and receive the $20 gift card.

I agree to receive phone calls from Kick It California.*

I agree to receive text messages. (Standard rates may apply.)

 By clicking Submit, I acknowledge that this information will be kept private as allowed by law. [Privacy policy](https://www.kickitca.org/privacy).

Back

 Submit

### It looks like you are not eligible for this program...

 ...however, we can still help you quit. Visit [ kickitca.org ](https://kickitca.org/) for more information on quit options.

Go Back

### This program is for California residents.

 For free help in your state, you can call the national quitline:

 1-800-QUIT-NOW 

[ Learn more about national resources ](https://www.cdc.gov/tobacco/quit_smoking/cessation/index.htm)

Start Over

## Thank You! Your referral is complete.

 A Quit Coach from Kick It California will call within 1–2 business days.

[ Learn more about Phone Coaching ](https://kickitca.org/our-program)

### Kick It California Coaching

 Kick It California is a free tobacco/nicotine quit program for California residents that has helped more than 1 million people since 1992.

 Within a couple days a Kick It California Coach will call you. They’ll ask a few questions about your tobacco/nicotine use and help create a personalized quit plan. After the call, you’ll receive a $20 gift card, while supplies last. 

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