Section Header


Refer a Client or Patient

To keep updated on program activities and new Talk Tobacco initiatives and promotions, we offer a newsletter for healthcare and other partners. Sign up today!

Evaluation referral programs indicate that 60% of those contacted by a Quit Coach would not have called, had they not been directly referred for proactive service

Refer a Client or Patient


*indicates required

Referral Options:

Online: Link to online referral form here

PrintDownload the referral form here, print, complete and email to or fax to1-877-513-5334

Web fillable: Complete the form online here, save and email to

Contact us to find out more by

  • Phone: 1 833 998-TALK (8255)
  • Live Chat: see live chat pop-up box on this page