NICORETTE® QuickMist Spray Survey

Thank you for letting NICORETTE® be part of your journey to quit smoking! We would appreciate it if you could take 3 minutes of your time to complete this survey to study the level of satisfaction among users after using NICORETTE® QuickMist Spray. To thank you for your participation, you will be rewarded with a $50 Grab Voucher* after completion of the survey!

*Voucher will be rewarded only after verification of purchase and if all questions are completed properly. While stocks last.


With the entrant’s consent, the Organizer will collect and process the entrant’s personal information, including full name, contact number and e-mail address. If the entrant does not provide these details, the entrant will unfortunately be unable to receive the gift upon completion of this form. Subject to some exceptions permitted by law, the entrant may request access to his/her personal information while the Organizer retains it. Reasons why will be given if access is denied. The entrant’s personal information will be securely destroyed once any statutory or other records retention period expires.

By entering this Testimonial Collection, the entrant consents to the processing of his/her personal information as described. The Organizer will process personal information in accordance with its Privacy Policy which entrant may view at

By clicking “Next Page” I agree with the above privacy notice and wish to participate in the survey.

QuickMist Survey


Please enter your first name and last name.

If you are not comfortable with it, you may enter an identifier, such as "K Tan".

Please enter your email.

This is a mandatory field as we would send the voucher to the stated email. Please ensure it is a valid email address as we will not be responsible if vouchers do not reach you due to wrong email address provided.


Please ensure image shows the whole receipt clearly.


Q1. How did you hear about NICORETTE® QuickMist Spray? *

You may select more than one option.

For Questions 2 to 7, please select the option that best represents how you feel about your experience using NICORETTE® QuickMist Spray.

Strongly Disagree Disagree Neutral Agree Strongly Agree

For Question 8, please select the option that best represents how you feel about your experience using NICORETTE® QuickMist Spray.

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied