Quit For Kids

Congratulations on starting your journey to be smoke-free! Whether you’re pregnant, a mom, dad, grandparent or family member living with a young child, quitting smoking is one of the best things that you can do for yourself and your family.

As part of this program, we will send you 2-3 text messages/week for 6 months. Pregnant women will receive messages for the duration of your pregnancy. Once you deliver, you can continue for 6 months and you are free to stop text messages at any time. This program does not replace your doctor’s care. Rather, it is meant to be extra help and support.

Please fill out this quick survey to make sure we send information that will be most helpful to you. Your information will be private. It will not be shared or used for any other purpose.

All questions are required.
Your Name*
First Last
Mobile Number*
County*
City*
Are you pregnant?
- Yes
- No
What is your estimated due date?*
MM slash DD slash YYYY
Are you currently the parent or caregiver of a newborn or child between the ages of newborn and 7?*
- Yes
- No
What is your youngest child's birth date?*
MM slash DD slash YYYY
This text message program is for parents with children younger than 8 years old.
Please indicate below your relationship with the child.*
This program is only available to people who are pregnant, or parents and caregivers to children between newborn and age 7.
Have you quit smoking, or are you currently smoking?*
- I am smoking less than I did one month ago
- I am smoking the same amount I always have
- I quit smoking, but I have started again
- I have increased my smoking in the past month
- I have quit smoking in the past month
Do you smoke in your vehicle?*
- Yes
- No
Is there anyone in your home currently smoking?*
- Yes
- No
How many people in your home are currently smoking?*
Are you interested in 1-on-1 support from a Quit Coach?*
- Yes
- No
A quit coach will contact you after you complete this survey with more information.
Terms & Conditions*
I have read and agree to the Terms & Conditions for this program
FHI Quit for Kids Texting Support Program Terms & Conditions

As a participant in the FHI Quit for Kids texting support text and web-based program, I agree to:

• Receive text and/or email messages related to my care at FHI or with its partner agencies.
• Click the links to view the educational information that will be sent to me.
• Complete and submit online and/or mobile program health survey(s).
• Contact FHI at 888-545-5191 with any questions about the information provided through the program or about my health condition or treatment.

As a participant in the FHI Quit for Kids text and web-based support program, I understand:

• I know that I am under no obligation to authorize FHI Quit for Kids to send me text messages through the FHI Quit for Kids texting support component of the program.
• Message/data rates may apply to messages sent by FHI Quit for Kids texting support program to my cell phone and that I may receive up to 12 texts per month.

Being in the program is voluntary. I may leave the program at any time. I can stop receiving text messages from the FHI Quit for Kids texting support program at any time by texting “STOP”. I can revoke consent for my Personal Health Information to be used by contacting Barbara Heinz, Program Coordinator at (856) 675-5326 or 2500 McClellan Ave, Suite 270, Pennsauken, NJ 08109.

This program is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services. Medical information provided by FHI and Gold Group Enterprises, Inc. dba GoMo Health (GoMo Health) is for informational and educational purposes only. After reading program messages or web pages, you are encouraged to review the information carefully with your provider. Information entered by you through the Platform will not be used to evaluate whether you should seek medical care. Never disregard professional medical advice, delay in seeking treatment, or rely on the information contained in this program in place of seeking professional medical advice. The information sent through text should not be considered as a medical consultation, nor is it meant to replace the provider’s decisions about the appropriateness or risks of a procedure given to a patient. If you think you may have a medical emergency, call your provider or 911 immediately.

Medical information changes constantly. FHI and GoMo Health do not guarantee the accuracy, adequacy, timeliness or completeness of any of the information on this site or on the linked websites and are not responsible for any errors, omissions, or any consequences arising from the use of the information contained at this or any linked website.

References to any entity, product, service or source of information not related to FHI and GoMo Health should not be considered an endorsement, either direct or implied, by FHI or GoMo Health. FHI and GoMo Health do not recommend or endorse any specific tests, products, procedures, opinions or other information that may be provided on any linked websites. The linked websites may contain text, graphics, images or information that you find offensive. FHI and GoMo Health have no control over and accept no responsibility for such materials.

We hope that you find this program useful in providing information about certain conditions and helpful in making your own health care decisions.

HIPAA Disclosure

Quit for Kids texting support program can send standard texts, as well as secure messages. I understand that standard text is not considered a secure technology and that any standard text messages that I receive may indicate the nature of my condition. Secure messages are accessible via secure webpage. Protected Health Information (PHI) will only be used and disclosed in accordance with HIPAA and applicable privacy laws.

Health Safety Procedures

I understand and acknowledge that this program is not a substitute for receiving proper care from an appropriate healthcare provider or following my healthcare provider’s recommended care plan. I understand the program is designed to give me background information that may be helpful in managing my condition. I understand that the information available through the program may not be complete or necessarily apply to my condition. I agree to contact my healthcare provider (or in the case of an emergency, dial 911) immediately if I have questions about the information provided and how it might apply to my particular medical condition.

Privacy Policy

FHI and GoMo Health respect your privacy. FHI Quit for Kids texting support program is a software platform with educational content that is distributed via a text or email care communication. GoMo Health does not sell, trade or rent your personal information to other companies or individuals. GoMo Health uses industry-leading Secure Sockets Layer (SSL) technology to keep your personal information as secure as possible. Participant information will only be used for its intended purpose.

FHI and GoMo Health may use information collected through services for research and development purposes. However, such usage will not include any personally identifiable information in such research or development. Personal information collected is stored in our secure cloud-based database, and we reserve the right to divulge information only as mandated to comply with state and federal laws.

Personal Information

GoMo Health aggregates the participant information voluntarily submitted to this program, to improve the program performance. GoMo Health may also receive Protected Health Information about participant health from FHI. GoMo Health may also aggregate the information from the two sources listed above.

Text and E-mail

When a participant sends a text message and/or email with program-specific data, their mobile phone number and/or e-mail address, the full content of the message, attached files, or other information provided may be recorded. The program may use this information to determine and send appropriate information or educational content to participants. Participants may indicate their preference to stop receiving communications or opt-out at any time. See Your Choices Regarding Your Protected Health Information section below.

Information Collected Via Technology

As you use these pages, certain message delivery information may be passively collected and stored on GoMo Health’s or our service providers’ server logs, including your Internet protocol address, browser type, and operating system. We also use Cookies and navigational data like Uniform Resource Locators (“URLs”) to gather information regarding the date and time of your web page visit and the information viewed. “Cookies” are small pieces of information that a website sends to your computer’s hard drive while you are viewing the site. An Internet protocol (or IP) address is a number that is automatically assigned to a participant computer when they use the Internet. In some cases, an IP Address may stay the same from browser session to browser session; but if participants use a consumer internet service provider (ISP), your IP Address will likely vary from session to session. The program may use both session Cookies (which expire once the web browser closes) and persistent Cookies (which remain on the computer until deleted) to provide a more personal and interactive program experience. Persistent Cookies can be removed by following the Internet browser’s help file directions. Participants may manage cookie preferences via browser settings (see http://www.allaboutcookies.org/ for more information).

Use and Disclosure of Information

In general, Protected Health Information and other information submitted and/or shared with the program may be used for the following purposes: to enable participant access to program services; to personalize the content received by the program; and/or to provide additional information and functionality upon request. Except as otherwise stated in this Privacy Policy, the program does not sell, trade, rent or otherwise share the Personal Information that we collect with third parties.

We may, when required, provide Protected Health Information to third-party service providers or affiliates who work on our behalf, to provide some of the services features necessary to help us communicate with participants. Examples of such services include sending texts or e-mails, analyzing data and providing customer service. Participant information provided under a Business Associate Agreement to the aforementioned affiliates and third-party service providers are not to be utilized in any manner except as necessary to provide the relevant program services. If you are not willing to allow the program to use or disclose your collected Personal Health Information as identified above, you may revoke your consent as described above.

The program uses Google Analytics to analyze how visitors interact with the program web site. This service provides non-personally identifiable data including but not limited to data on where visitors came from, what actions they took on our site and where visitors went when they left our site.

The program may also develop non-personal information concerning visitors to GoMo Health web pages, using de-identification processes to help ensure that such information cannot reasonably be re-associated or connected with participants. Generally, this information is de-identified and aggregated to be used in statistical analysis to help analyze patterns of use. This Privacy Policy does not limit use or disclosure of de-identified information (i.e., that is not connected with an individual user) in any way, and we reserve the right to use and disclose such information to program partners, sponsors and other third parties at our discretion.

In the event we go through a business transition such as a merger, acquisition by another company or sale of all or a portion of our assets, your Protected Health Information may be among the assets transferred. Program participants acknowledge that such transfers may occur and are permitted by this Privacy Policy and that any acquirer will continue to process Personal Health Information with HIPAA compliance and as set forth in this Privacy Policy.

The program may disclose Protected Health Information if necessary, to comply with relevant laws or to respond to subpoenas or warrants served on us. You hereby consent to us sharing your Personal Health Information under the circumstances described herein.

Prohibited Uses of the Platform

You shall not transmit, redistribute, or promote any communications, content, or materials that (a) contain corrupted files, viruses, or any other similar software files, the intent of which is to damage the operation of another’s computer; (b) are unlawful, threatening, harassing, abusive, defamatory, invasive of privacy or publicity rights, obscene, or otherwise objectionable; (c) infringes, misappropriates, or violates the intellectual property rights or other rights of any third party; (d) impersonate any person, business, or entity, including our company, employees, or agents; (e) violate any law (including, but not limited to, HIPAA); or (f) amounts to any conduct that, in our judgment, restricts, impairs, interferes, or inhibits any other user from using or enjoying, or is otherwise detrimental to, the Platform. You shall not: (g) use automated means, including spiders, robots, crawlers, data mining tools, or the like to download data from the Platform; (h) cover, obscure, block, or in any way interfere with any advertisements and/or safety features (e.g., report abuse button) on the Platform; or (i) access or use the Platform to collect any market research for a competing business.

DISCLAIMER AND LIMITATION OF LIABILITY

THE CONTENT PROVIDED ON THE PLATFORM AND IN ANY OTHER COMMUNICATIONS FROM, OR PROVIDED THROUGH, THE PLATFORM IS NOT INTENDED AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. GOMO HEALTH MAKES NO REPRESENTATIONS OR WARRANTIES, WHETHER EXPRESSED OR IMPLIED, WITH RESPECT TO THE ACCURACY AND COMPLETENESS OF THE CONTENT AS IT RELATES TO YOUR MEDICAL HISTORY OR MEDICAL RECORDS.

YOU ACKNOWLEDGE THAT THE PLATFORM MAY CONTAIN BUGS, ERRORS, AND OTHER PROBLEMS THAT COULD CAUSE SYSTEM FAILURES. CONSEQUENTLY, THE PLATFORM AND THE CONTENT ARE PROVIDED “AS IS” AND “AS AVAILABLE” WITHOUT ANY WARRANTIES OF ANY KIND, INCLUDING THAT THE PLATFORM OR CONTENT WILL OPERATE ERROR-FREE OR THAT THE PLATFORM, ITS SERVERS, OR THE CONTENT ARE FREE OF COMPUTER VIRUSES OR SIMILAR CONTAMINATION OR DESTRUCTIVE FEATURES.

GOMO HEALTH AND FHI DISCLAIM ALL WARRANTIES, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF TITLE, MERCHANTABILITY, NON-INFRINGEMENT OF THIRD PARTIES’ RIGHTS, AND FITNESS FOR PARTICULAR PURPOSE AND ANY WARRANTIES ARISING FROM A COURSE OF DEALING, COURSE OF PERFORMANCE, OR USAGE OF TRADE.

IN CONNECTION WITH ANY WARRANTY, CONTRACT, OR COMMON LAW TORT CLAIMS: (I) GOMO AND FHI SHALL NOT BE LIABLE FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES, LOST PROFITS, OR DAMAGES RESULTING FROM LOST DATA OR BUSINESS INTERRUPTION RESULTING FROM THE USE OR INABILITY TO ACCESS AND USE THE PLATFORM OR THE CONTENT, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES; AND (II) ANY DIRECT DAMAGES THAT YOU MAY SUFFER AS A RESULT OF YOUR USE OF THE PLATFORM OR THE CONTENT SHALL BE LIMITED TO FIFTY UNITED STATES DOLLARS (US$50). SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF CERTAIN WARRANTIES. THEREFORE, SOME OF THE ABOVE LIMITATIONS ON WARRANTIES IN THIS SECTION MAY NOT APPLY TO YOU.

Termination

We reserve the right, in our sole discretion, to restrict, suspend, or terminate your access to all or any part of the Platform, at any time and for any reason without prior notice or liability. We reserve the right to change, suspend, or discontinue all or any part of the Platform at any time without prior notice or liability.

Your Choices Regarding Your Protected Health Information

This program offers choices to participants regarding the collection, use and sharing of their Protected Health Information. Participants have a right at any time to unsubscribe and discontinue program contact by replying “STOP” at any time after receiving a text message. Participants may contact GoMo Health directly, via email, at support@mymobilemsg.com.
This text program is not meant to replace regular medical care provided by your doctor, but to enhance the care plan provided from your doctor. Be sure to visit your doctor regularly.
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