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TOBACCO CESSATION C L I N I C R e g i s t r a t i o n F o r m (I n t a k e an n d F o l l o w U p) Note: This is the minimum required information for the database. The health care facility is encouraged

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How to fill out tobacco cessation clinic registration

01

Step 1: Locate the tobacco cessation clinic registration form.

02

Step 2: Fill out your personal information accurately, including your full name, date of birth, and contact information.

03

Step 3: Provide information about your smoking habits, such as the number of cigarettes you smoke per day and how long you have been smoking.

04

Step 4: Answer any additional questions or queries related to your medical history or previous attempts to quit smoking.

05

Step 5: Sign the registration form, indicating your consent to participate in the tobacco cessation clinic.

06

Step 6: Submit the completed registration form to the designated clinic or healthcare facility according to their instructions.

Who needs tobacco cessation clinic registration?

01

Individuals who are interested in quitting smoking and are seeking professional assistance.

02

People who want to participate in a tobacco cessation clinic program and receive support in their journey to quit smoking.

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What is tobacco cessation clinic registration?

Tobacco cessation clinic registration is a process through which clinics that offer services to help individuals quit tobacco use are officially registered with the relevant authorities.

Who is required to file tobacco cessation clinic registration?

Any clinic that provides tobacco cessation services is required to file for tobacco cessation clinic registration.

How to fill out tobacco cessation clinic registration?

To fill out tobacco cessation clinic registration, clinics need to submit the necessary forms and documentation to the appropriate governing body.

What is the purpose of tobacco cessation clinic registration?

The purpose of tobacco cessation clinic registration is to ensure that clinics offering tobacco cessation services meet certain standards and regulations to provide quality care to patients.

What information must be reported on tobacco cessation clinic registration?

Information such as clinic name, location, services offered, staff qualifications, and contact information must be reported on tobacco cessation clinic registration.

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