Refer your clients for proactive phone support

Any healthcare provider or allied health professional in SK, MB, PE or YT can refer their clients to Smokers’ Helpline using the online referral form below or by fax at 1-877-513-5334 using a Quit Connection referral form.

Any healthcare provider or allied health professional in Ontario can refer their First Nation, Inuit, Métis and urban Indigenous clients to Talk Tobacco using the online referral form below or by fax at 1-877-513-5334 using a Talk Tobacco Quit Connection referral form.

In Ontario, clients can be referred to Telehealth Ontario's Smoking Cessation service via this online form or the Telehealth Ontario referral form which may be faxed to 1-888-857-6555 or 519-434-9028.

Tips for making successful referrals:

  • Make a cessation intervention a systematic part of your care
  • Keep this referral form bookmarked or printed forms accessible and fully stocked
  • Photocopy the form with your contact information already filled out
  • Contact us to order promotional and support materials such as referral forms and Talk Tobacco referral cards
  • Before submitting, print the completed page and file the referral form with your client’s chart  

Healthcare provider information

Patient/client information

Smokers' Helpline usually calls within 3 business days. When should we call?

Time of day

Consent to contact: