Any healthcare provider practicing in Ontario can refer their clients to Smokers’ Helpline using our online referral form (see below) or by fax at 1-877-513-5334 using a Quit Connection referral form. Minimal contact intervention is quick, easy and effective and Smokers’ Helpline will do the rest.

When making a Quit Connection referral, many clinicians will follow the 3 A's:

  1. Ask about tobacco use at every visit. 
  2. Advise your client to quit.
  3. Arrange for additional support by directly referring to Smokers' Helpline

Tips for making successful referrals:

  • Make a cessation intervention a systematic part of your care
  • Keep Quit Connection online referral form bookmarked or printed forms accessible and fully stocked
  • Photocopy the form with your contact information already filled out
  • Contact Smokers’ Helpline for promotional materials and support tools
  • Once submitted, file the referral form with your client’s chart  

Quit Connection Referral Forms

Download the appropriate referral form for your province below and send it to us.

**Health Connect Ontario Referral Form** (pdf)
Download (135 KB)
Manitoba Quit Connection (pdf)
Download (254 KB)
Prince Edward Island Quit Connection (pdf)
Download (254 KB)
Saskatchewan Quit Connection (pdf)
Download (254 KB)
Yukon Quit Connection (pdf)
Download (266 KB)