Do You Want to Quit Smoking?

Are you a smoker who wants to stop and plans to quit in the next week or so? If so, ABC News wants to hear from you.

An estimated 45.8 million Americans smoke cigarettes, and more than 70 percent of all smokers say they want to stop.

If you're a smoker hoping to quit, ABC News want to know how long you have smoked and why you started. Have you tried to quit before? How are you quitting -- alone, with a group, cold turkey, or with a nicotine patch?

If you would like to share your story on camera with ABC News, please fill out the form below, and be sure to include day and evening phone numbers and your location. You may be contacted by an ABC News producer.

Name:

Daytime Telephone:

Evening Telephone:

E-mail address:

Hometown:

Your story:

Thanks!

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