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Get the free Michigan Tobacco Quitline - PATIENT FAX REFERRAL FORM (rev ... - michigancancer

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PATIENT FAX REFERRAL FORM Fax to: 1-800-261-6259 Today s Date Use this form to refer patients who are ready to quit tobacco in the next 30 days to the Michigan Tobacco Quit line. PROVIDER(S): Complete
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How to fill out michigan tobacco quitline

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How to fill out Michigan Tobacco Quitline:

01
Visit the official website of the Michigan Tobacco Quitline or call their toll-free number.
02
Provide your personal information such as your name, address, and contact details.
03
Answer the questions regarding your tobacco usage, smoking habits, and reasons for quitting.
04
Choose your preferred method of quitting, whether it's through counseling, medications, or a combination.
05
Specify the date you plan to quit or have already quit smoking.
06
If desired, share any specific concerns or challenges you may be facing in your journey to quit smoking.
07
Review and confirm all the information provided before submitting your application.

Who needs Michigan Tobacco Quitline:

01
Smokers who are looking to quit smoking and need assistance and resources to support their journey.
02
Individuals who have tried to quit smoking in the past but have been unsuccessful and are seeking additional help.
03
People who are in need of professional counseling, guidance, and personalized quit plans to increase their chances of successfully quitting tobacco.
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The Michigan Tobacco Quitline is a free telephone-based counseling service designed to help people quit smoking and tobacco use.
Healthcare providers and organizations in Michigan that provide services related to tobacco cessation are required to report to the Michigan Tobacco Quitline.
To fill out the Michigan Tobacco Quitline, healthcare providers and organizations can visit the official website or call the Quitline directly for instructions on reporting.
The purpose of the Michigan Tobacco Quitline is to provide resources and support to individuals looking to quit smoking and tobacco use.
Healthcare providers and organizations are required to report data on the number of patients referred to the Quitline, the types of services provided, and the outcomes of the interventions.
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