Any healthcare provider practicing in Ontario can refer their clients to Smokers’ Helpline using our online referral form (see below) or by fax at 1 877 513-5334 using a Quit Connection referral form. Minimal contact intervention is quick, easy and effective and Smokers’ Helpline will do the rest.

When making a Quit Connection referral, many clinicians will follow the 3 A's:

  1. Ask about tobacco use at every visit. 
  2. Advise your client to quit.
  3. Arrange for additional support by directly referring to Smokers' Helpline

Tips for making successful referrals:

  • Make a cessation intervention a systematic part of your care
  • Keep Quit Connection online referral form bookmarked or printed forms accessible and fully stocked
  • Photocopy the form with your contact information already filled out
  • Contact Smokers’ Helpline for promotional materials and support tools
  • Once submitted, file the referral form with your client’s chart

Quit Connection Referral Forms

Download the appropriate referral form for your province below and send it to us.

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Manitoba Quit Connection (pdf)
Download (92 KB)
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New Brunswick Quit Connection (pdf)
Download (92 KB)
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Ontario Quit Connection (pdf)
Download (219 KB)
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Prince Edward Island Quit Connection (pdf)
Download (92 KB)
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Saskatchewan Quit Connection (pdf)
Download (92 KB)
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Yukon Quit Connection (pdf)
Download (92 KB)