Dominant Vapor Customer Survey
Anonymous statistcal data obtained from this form will be used as part of a Pre-Market Tobacco Application (PMTA) submission to the FDA. We will not share your information in any other way without your prior consent. Your responses are important to ensure continued availability of our products beyond the 9/9/2020 deadline.
Today's Date *
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First Name (Initials OK) *
Last Name (Initials OK) *
Current Age *
Have you ever smoked? *
Required
Do you smoke & vape? *
Required
Do you currently smoke? *
Required
How many years have you vaped? *
How many years have you smoked? *
What was your starting nicotine strength in mg/ml *
What is your current nicotine strength in mg/ml *
Is it your goal not to use tobacco products of any kind? *
Required
If you currently vape and smoke, is it your goal to quit smoking? *
Required
Do you vape flavors other than tobacco? *
Required
If tobacco flavor was only available, would you return to smoking combustible cigarettes? *
Required
Have you ever tried FDA approved smoking cessation methods i.e. Gums, Patches, Chantix? *
Required
Is the use of an ENDS (vape) product helpful in keeping you from using a combustible tobacco product i.e. cigarettes or cigars? *
Required
Without vaping would you return to smoking combustible cigarettes? *
Required
Tell the FDA how Dominant Vapor has helped you here (optional):
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