Fax Referral Form
What is it?
A program designed to make it easy for health care providers to refer their patients/clients to AlbertaQuits Helpline for assistance to quit smoking.
2 Easy Steps!
The program connects your patient, who is willing to quit, with a Cessation Counsellor at AlbertaQuits Helpline.
- Download the Fax Referral Form and review with your client the best time to be called at home prior to faxing it in.
- Fax the form to AlbertaQuits Helpline at 1.866.979.3553 for direct follow-up with your patient.