Get the free NSW Quitline Referral Form. NSW Quitline Referral Form

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NSW Quit line Referral Form Fax the completed form to: 02 9698 2740 (If you receive this fax by mistake, please relax to above number)Client/patient details Given Names:Surname:Sex:Date of birth:(Optional)Age:(Optional)Male

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How to fill out nsw quitline referral form

01

Step 1: Go to the NSW Quitline website

02

Step 2: Download the referral form

03

Step 3: Fill out all required fields including personal information and reason for referral

04

Step 4: Save the completed form on your device

05

Step 5: Submit the form electronically or print and mail it to the NSW Quitline

Who needs nsw quitline referral form?

01

Individuals who want to seek help to quit smoking in New South Wales

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What is nsw quitline referral form?

The NSW Quitline referral form is a document used to refer individuals to the Quitline service, which provides support and resources for people looking to quit smoking.

Who is required to file nsw quitline referral form?

Healthcare professionals, including doctors and nurses, as well as organizations involved in smoking cessation efforts, are typically required to file the NSW Quitline referral form on behalf of their patients or clients.

How to fill out nsw quitline referral form?

To fill out the NSW Quitline referral form, provide the necessary information about the individual being referred, including their contact details, smoking history, and any relevant medical information. Follow the instructions provided on the form for submission.

What is the purpose of nsw quitline referral form?

The purpose of the NSW Quitline referral form is to facilitate access to smoking cessation support services, ensuring individuals receive the help they need to quit smoking effectively.

What information must be reported on nsw quitline referral form?

The information that must be reported on the NSW Quitline referral form includes the individual's name, contact information, smoking history, and any relevant medical conditions that may affect their quit attempt.

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