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Quit4Wellbeing Case Study

Thank you for taking the time to share your experience with our stop smoking service.

We are collecting real-life stories from people who have used our support to help others understand what the journey to quitting smoking can look like. Your experience can help inspire and motivate others who may be thinking about quitting, as well as highlight the support available through our service.

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Consent Form

The County Council would like to hear peoples' experiences of Quit4Wellbeing Stop Smoking Service in West Sussex. This form explains how your information may be used and asks for your consent to be featured in case study materials for promotional and educational purposes. 

 

Purpose of the Case Study:

We would like to share real-life success stories from clients who have used the Quit4Wellbeing Stop Smoking Service. Your story could be used to:

  • Promote the Quit4Wellbeing service in local media, on social media, websites, printed materials, and presentations.
  • Inform and encourage others who are thinking about stopping smoking.
  • Help health professionals understand the impact of our service. 

 

Information We May Collect and Use

If you agree, we may collect and share:

  • Your stop smoking story (e.g., your reasons for quitting, challenges, motivations, and successes). 
  • Your experience of using the Quit4Wellbeing service. 
  • Basic demographic details such as your age, gender, ethnicity, and occupation.
  • Quotes, photographs, or video/audio recordings (with your consent).
  • Your first name (or a pseudonym if you prefer to remain anonymous).

We will aim to share the final case study with you before publishing when possible. 

 

How Your Information Will Be Used

Your information may appear in:

  • Publicity and promotional materials (e.g., posters, leaflets, newsletters). 
  • Reports or presentations to stakeholders. 
  • Websites or social media accounts managed by Quit4Wellbeing or our partners.
  • We will store your information securely and use it only for the purposes described above.


If you wish to view the Quit4Wellbeing Privacy Notice, please visit: www.westsussex.gov.uk/about-the-council/information-and-data/data-protection/privacy-notices/quit4wellbeing-privacy-notice/


You can withdraw your consent to share your experiences at any time. 

This will stop any future use of our record of your experiences, but it will not be possible to remove it from any existing printed literature which has been issued.

You will need to contact Chelsey Hallam by email at: chelsey.hallam@westsussex.gov.uk to notify us that you wish to withdraw your consent to share your experiences.


1.  

Please read the statements below and tick the boxes to indicate your consent: 

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2.  

I understand that:

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3.  

We may wish to publish your written case study in the following communication channels. Please tick each box you consent to having this information shared.  

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4.  

We may wish to publish your photograph that you provide in the following communication channels. Please tick each box you consent to having this information shared.  

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