“I didn’t want cigarettes to be in control of my life.”
–Kelli
Ex-Smoker
You don't have to go it alone. Because MyQuitTM is here to help with added support.
Attribute code :A_FNAME
Reg-Ex pattern: ^[A-Za-z]*$
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: Invalid entry. The name you enter may only contain letters from the alphabet.
Mandatory error message :Please enter your First Name.
Input type Textbox?true
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_EML
Reg-Ex pattern: ^[\w_-]+(\.[\w_-]+)*@[\w_-]+(\.[\w_-]+)*\.\w{2,4}$
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: Invalid email. Please re-enter your email in the following format: email@domain.com.
Mandatory error message :Please enter a valid Email Address.
Input type Textbox?true
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_LNAME
Reg-Ex pattern: ^[A-Za-z]*$
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: Invalid entry. The name you enter may only contain letters from the alphabet.
Mandatory error message :Please enter your Last Name.
Input type Textbox?true
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_PROF_PSWD
Reg-Ex pattern: ^.{6,}$
Min length for field: 6
Max length for field:$max-length
Reg-Ex error message: Invalid password. Your password must be at least six (6) characters long.
Mandatory error message :Password must be at least 6 characters.
Input type Textbox?true
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_PROF_HOMZIPCode
Reg-Ex pattern: ^[0-9]*$
Min length for field: 5
Max length for field:$max-length
Reg-Ex error message: You must enter your 5-digit zip code in order to sign up.
Mandatory error message :Please enter your zip code.
Input type Textbox?true
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_MYQUIT_REGTYPE
Reg-Ex pattern: $regexpattern
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: $regexMessage
Mandatory error message :Please select your quit-smoking status
Input type Textbox?$input-type-textbox
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?true
Input type Radio button?$input-type-radio
Attribute code :A_MYQUIT_QUITDATE
Reg-Ex pattern: $regexpattern
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: $regexMessage
Mandatory error message :Please enter the planned quit date.
Input type Textbox?$input-type-textbox
Input type Textarea?$input-type-textarea
Input type DatePicker?true
Input type Checkbox?$input-type-checkbox
Input type Select ?$input-type-select
Input type Radio button?$input-type-radio
Attribute code :A_MYQUIT_PRODUCT
Reg-Ex pattern: $regexpattern
Min length for field: $min-length
Max length for field:$max-length
Reg-Ex error message: $regexMessage
Mandatory error message :Please select a product
Input type Textbox?$input-type-textbox
Input type Textarea?$input-type-textarea
Input type DatePicker?$input-type-datepicker
Input type Checkbox?$input-type-checkbox
Input type Select ?true
Input type Radio button?$input-type-radio
