Entrance questionnaire

To begin your Coach program, we ask you to answer a few questions. These questions will allow us to send you personalized recommendations, tailored to fit your situation.

After you have answered this questionnaire you will receive from us:

 a personal analysis of your situation with advice, charts and feedback
 detailed instructions (Report)
 an interactive personal page
 Email coaching for several months

We guarantee that no personal data, including your email address, will be transferred to third parties.



Password (no accents or spaces, please)
Password (Confirmation)
Smoker / Ex-smoker
I accept that my answers will be recorded, in an anonymous format, for the constitution of my interactive personal page and my support by Email, and for statistical reasons.
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