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OUTLINE REFERRAL SITE REGISTRATION FORM PLEASE PRINT CLEARLY ALL INFORMATION IS Requisite Name: Mailing Address: City: County:, VA Zip code Clinic/Health Dept./Practice/Office FAX NUMBER: () Contact

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What is quitline referral site registration?

Quitline referral site registration is a process of registering a site that refers individuals to a quitline for assistance with quitting tobacco use.

Who is required to file quitline referral site registration?

Any organization or individual that operates a website or platform that refers individuals to a quitline is required to file quitline referral site registration.

How to fill out quitline referral site registration?

To fill out quitline referral site registration, you need to provide information about the website or platform, the quitline being referred to, and contact information.

What is the purpose of quitline referral site registration?

The purpose of quitline referral site registration is to ensure that organizations or individuals referring smokers to quitlines are providing accurate information and following best practices.

What information must be reported on quitline referral site registration?

Information such as the website URL, the quitline being referred to, contact information, and any additional relevant details must be reported on quitline referral site registration.

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