Refer A Tobacco User

Quit Tobacco Referral Form

Quitting tobacco is often the most important thing a person can do for their future health. Advice and assistance from a provider remains a powerful tool in helping tobacco users quit. Clinical, behavioral health, and social service providers can increase a patient and client’s success in becoming tobacco-free by connecting them to proven resources. Tobacco users are 2-3 times more likely to quit with the support of the phone coaching than when they try it alone.

Get information and resources on referring to the Maine QuitLink through CTIMaine.org:

Social Service Providers can complete this form to connect your client to the Maine QuitLink. They will receive a call from a Quit Coach with more information and have the opportunity to enroll in the free counseling program.  On July 31, 2020 this form will be moving to CTIMaine.org.

 

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Please make sure you have the permission of the individual whose information is being submitted as the HelpLine does need to speak with that individual directly.

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What are the best times for the Maine QuitLink to call?

8am - 11am11am - 2pm2pm - 5pmAfter 5pm

Is it ok to leave a message at this number?

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