Get the free Stop Smoking Service Referral Form - NHSGGC

Stop Smoking Service. Referral Form. Please contact my patient for smoking cessation. Patient Details. Name: ...

How to fill out stop smoking service referral

How to fill out a stop smoking service referral:

1. Gather necessary information: Collect the individual's name, contact information, and any other essential details required by the referral form.
2. Identify the appropriate stop smoking service: Research and determine the suitable stop smoking service that aligns with the individual's needs and preferences.
3. Obtain the referral form: Obtain a copy of the stop smoking service referral form, which can usually be provided by healthcare professionals, clinics, or the chosen stop smoking service itself.
4. Fill out personal information: Begin by filling out the individual's personal information, such as their full name, date of birth, address, phone number, and email address.
5. Provide relevant medical history: Inquire about the individual's medical history in relation to smoking, including any existing health conditions or medications they may be taking. This information helps the stop smoking service tailor their approach.
6. Indicate preferred communication method: Determine the individual's preferred method of communication for follow-up appointments, whether it is through phone calls, emails, or in-person visits.
7. Specify desired services: Express the specific stop smoking services or programs the individual is interested in or has been recommended. This can range from counseling sessions, nicotine replacement therapy, prescription medication, or group support.
8. Include additional notes: If there are any additional notes or relevant information that may assist the stop smoking service in providing personalized assistance, include them in the appropriate section of the referral form.
9. Seek healthcare provider's endorsement: If required, request a healthcare provider, such as a general practitioner or specialist, to endorse or sign the referral form to indicate their support and recommendation.
10. Submit the referral form: Once completed, submit the filled-out referral form to the designated stop smoking service by mail, fax, email, or through an online submission process if available.

Who needs stop smoking service referrals?

1. Individuals struggling with tobacco addiction: Those who are actively trying to quit smoking or seeking support to overcome tobacco addiction might need a stop smoking service referral.
2. Smokers in need of professional guidance: Smokers who have tried to quit before without success or those who require extra support and resources to quit smoking may benefit from a stop smoking service referral.
3. Healthcare professionals recommending cessation support: Healthcare providers, including doctors, nurses, or counselors who come across patients who smoke and express a desire to quit, may refer them to a stop smoking service for specialized assistance.

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What is stop smoking service referral?

Stop smoking service referral is a process where individuals are referred to services and support to help them quit smoking.

Who is required to file stop smoking service referral?

Healthcare professionals, social workers, and other professionals may be required to file stop smoking service referrals.

How to fill out stop smoking service referral?

Stop smoking service referral can be filled out by providing information about the individual, their smoking habits, and any relevant medical history.

What is the purpose of stop smoking service referral?

The purpose of stop smoking service referral is to connect individuals with resources and support to help them quit smoking.

What information must be reported on stop smoking service referral?

Information such as the individual's name, contact information, smoking history, and any relevant medical conditions may need to be reported on stop smoking service referrals.