Healthcare & Partners
Online Referral Form
Any healthcare provider or allied health professional in British Columbia, Manitoba, Ontario and Saskatchewan can refer their First Nation, Inuit, or Métis clients to Talk Tobacco by:
Online: Complete and submit the form below
We collect your personal information through forms, by phone or in person to manage your participation in the program, inform you about other services and contact you to provide updates about our impact and ways to support us or give. We may also use your information for program evaluation and quality assurance. We may share your personal information with third parties including service providers, consultants and advisors outside your province or territory or outside of Canada only to carry out the purposes identified above, or as required by law. We may contact you by mail, email, phone or text. You can exercise your right to access your information or have it corrected, unsubscribe from communications or withdraw your consent by calling 1-888-939-3333 or emailing firstname.lastname@example.org. For more information about our privacy practices, visit cancer.ca/privacy.