Quit-Now Referral Forms

With patient consent, mental health or medical providers can directly enroll patients to the QUIT-NOW free support for quitting nicotine using the following forms:

Email Referral Process QUIT-NOW

Fax-Referal-Form QUIT NOW

NM-Spanish-Fax-Referral-Form QUIT NOW

People are more likely to quit commercial tobacco/nicotine with the support of their healthcare provider. Direct enrollment removes barriers to help people who want to quit.

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With patient consent, mental health or medical providers can directly enroll patients to the QUIT-NOW free support for quitting nicotine using the following forms:

Email Referral Process QUIT-NOW

Fax-Referal-Form QUIT NOW

NM-Spanish-Fax-Referral-Form QUIT NOW

People are more likely to quit commercial tobacco/nicotine with the support of their healthcare provider. Direct enrollment removes barriers to help people who want to quit.

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