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.

Description

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.