Get the free QUITLINE REFERRAL FORM - deadlychoices.com.au

OUTLINE REFERRAL FORM CLIENT / PATIENT DETAILS Family name: First name: Date of birth: / / Gender: Male FemalePostcode: Preferred phone number: Secondary contact: Do you identify as: Aboriginal Torres

How to fill out quitline referral form

How to fill out quitline referral form

1. Start by obtaining a copy of the quitline referral form.
2. Fill in your personal information, including your name, contact details, and any other information required by the form.
3. Provide details about your smoking habits, such as the number of cigarettes smoked per day and the duration of smoking.
4. Describe any previous attempts at quitting smoking and the methods used.
5. Indicate your preferred method of contact for follow-up communication.
6. If applicable, provide information about your healthcare provider and any additional relevant healthcare information.
7. Read over the completed form to ensure all information is accurate and complete.
8. Sign and date the form.
9. Submit the form to the appropriate entity, as specified on the form.
10. Keep a copy of the form for your records.

Who needs quitline referral form?

1. Anyone who wishes to seek assistance from a quitline program can use the quitline referral form.
2. This form is typically used by individuals who want help to quit smoking or who are seeking support and resources to stop smoking.
3. Healthcare providers may also use this form to refer patients to quitline services.

For pdfFiller’s FAQs

What is quitline referral form?

The quitline referral form is a document used to refer individuals to a hotline for support and resources to help them quit smoking or using tobacco products.

Who is required to file quitline referral form?

Healthcare providers, counselors, or anyone working with individuals trying to quit smoking may be required to file a quitline referral form.

How to fill out quitline referral form?

To fill out a quitline referral form, one must provide the individual's name, contact information, smoking history, and reasons for wanting to quit.

What is the purpose of quitline referral form?

The purpose of the quitline referral form is to connect individuals with resources and support to aid them in quitting smoking or using tobacco products.

What information must be reported on quitline referral form?

Information such as the individual's name, contact information, smoking history, and reasons for wanting to quit must be reported on the quitline referral form.

How can I manage my quitline referral form directly from Gmail?

quitline referral form and other documents can be changed, filled out, and signed right in your Gmail inbox. You can use pdfFiller's add-on to do this, as well as other things. When you go to Google Workspace, you can find pdfFiller for Gmail. You should use the time you spend dealing with your documents and eSignatures for more important things, like going to the gym or going to the dentist.

How do I make changes in quitline referral form?

With pdfFiller, the editing process is straightforward. Open your quitline referral form in the editor, which is highly intuitive and easy to use. There, you’ll be able to blackout, redact, type, and erase text, add images, draw arrows and lines, place sticky notes and text boxes, and much more.

How do I fill out quitline referral form using my mobile device?

On your mobile device, use the pdfFiller mobile app to complete and sign quitline referral form. Visit our website (https://edit-pdf-ios-android.pdffiller.com/) to discover more about our mobile applications, the features you'll have access to, and how to get started.