Get the free Referral Form - quittas.org.au

Referral Form Date Outline (Tasmania)Fax Number03 6169 1941Emailquitline quits.org.referred by Organization Telephone Email CLIENT DETAILS Name (please print) Address Date of birth Preferred Phone

How to fill out referral form - quittasorgau

How to fill out referral form - quittasorgau

1. Start by obtaining the referral form from the quittas.org.au website.
2. Fill in the necessary personal details such as your name, contact information, and date of birth.
3. Provide information about your tobacco or nicotine use, including the frequency and amount of use.
4. Answer any additional questions that may be asked on the form, such as your current health status and any previous quit attempts.
5. If applicable, provide details of the healthcare professional who is referring you, including their name, contact information, and signature.
6. Review the completed form for any errors or missing information before submitting it.
7. Submit the referral form through the designated method specified on the quittas.org.au website, such as via email or by mailing it to the provided address.
8. Wait for confirmation of receipt and further instructions from quittas.org.au regarding your referral.

Who needs referral form - quittasorgau?

1. Anyone who requires assistance in quitting tobacco or nicotine use can benefit from filling out a referral form on quittas.org.au. This includes individuals who want to quit smoking, using smokeless tobacco products, or using nicotine replacement therapies. The referral form allows individuals to access resources, support, and guidance from quittas.org.au to help them successfully quit and lead a healthier lifestyle.

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What is referral form - quittasorgau?

The referral form - quittasorgau is a document used to refer individuals to the Quitline for assistance with smoking cessation.

Who is required to file referral form - quittasorgau?

Healthcare professionals, employers, or concerned individuals can file the referral form - quittasorgau.

How to fill out referral form - quittasorgau?

The referral form - quittasorgau can be filled out online on the Quitline website by providing the required information about the individual being referred.

What is the purpose of referral form - quittasorgau?

The purpose of the referral form - quittasorgau is to provide support and resources to individuals looking to quit smoking.

What information must be reported on referral form - quittasorgau?

The referral form - quittasorgau typically requires information such as the individual's name, contact information, smoking history, and reason for referral.