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Quitline referral forms

Quitline referral forms are now available from the Alcohol and Other Drugs Program. Each pad contains 50 forms to be completed by both the health professional and the patient/client and is then faxed to the Quitline.

It's that simple!

The Quitline will contact your patient/client directly according to the times indicated on the form. Quitline support can range from simply requesting a free Quit pack, to intense support with follow up support calls over a period of 3 months.

The Northern Territory Quitline 3 month follow up support has the highest Quit success rates in Australia. The Quitline can also cater for non-English speaking backgrounds.

For further information or to order your FREE Quitline referral forms for your ward/clinic, contact Warwick Kneebone, Coordinator Tobacco Enforcement and Education, on 8999 2661 or email warwick.kneebone@nt.gov.au.

The forms and cover page are also available for download:

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