Patient reference form from health facilities

These forms are for health care providers who want to refer their smoking patient to the I QUIT NOW services. The patient should receive a phone call in 1 or 2 business days after you have submitted the form. The specialists of the I QUIT NOW quitline will receive the completed forms and will offer patients the help of the I QUIT NOW services consisting of:

  • Online help offered by the I QUIT NOW website;
  • Help by phone offered by the I QUIT NOW quitline;
  • Help in person offered by the Quit Smoking Centres of their region;
  • Help by text message offered by the SMAT.