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. 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. 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 the Tobacco hotline 1800 888 564 or email us.
The forms and cover page are also available for download:
