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Date of Referral (YYY/MM/DD): PATIENT INFORMATIONREFERRAL SOURCE INFORMATION(please print or place patient sticker here)(sticker/stamp can be placed here) This is my first referral to Telehealth Ontario
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How to fill out online smoking cessation referral

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How to fill out online smoking cessation referral

01
Step 1: Open a web browser and navigate to the smoking cessation referral website.
02
Step 2: Find the online referral form on the website and click on it to open.
03
Step 3: Provide your personal information, such as name, contact details, and date of birth.
04
Step 4: Answer any questions or prompts related to your smoking habits, such as how long you have been smoking, how many cigarettes you smoke per day, and any previous attempts to quit smoking.
05
Step 5: Confirm your willingness and commitment to quitting smoking by selecting the appropriate options or checkboxes.
06
Step 6: Review all the information you have provided and make sure it is accurate.
07
Step 7: Submit the online smoking cessation referral form.
08
Step 8: Wait for a confirmation or follow-up communication from the referral program or organization.

Who needs online smoking cessation referral?

01
Anyone who wants to quit smoking and is looking for professional assistance and support can benefit from an online smoking cessation referral. It is especially useful for individuals who have tried to quit smoking in the past but were unsuccessful, as well as those who prefer the convenience and privacy of online resources. Additionally, healthcare professionals may also recommend online smoking cessation referrals to their patients as part of their overall treatment plan.
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Online smoking cessation referral is a process where individuals can refer themselves or others to resources and support programs to help quit smoking.
Anyone who is interested in quitting smoking or helping someone quit smoking can file an online smoking cessation referral.
Online smoking cessation referral forms can typically be filled out on a designated website by providing personal information and details about smoking habits.
The purpose of online smoking cessation referral is to connect individuals with the necessary resources and support to help them quit smoking successfully.
Information such as contact details, smoking history, current smoking habits, motivation to quit, and any previous attempts to quit may be required on an online smoking cessation referral form.
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