Section Header

Healthcare & Partners

Online Referral Form

Any healthcare provider or allied health professional in British Columbia, Manitoba, Ontario and Saskatchewan can refer their First Nation, Inuit, or Métis clients to Talk Tobacco by:

Online: Complete and submit the form below

Print: Download the referral form here, print, complete and email to or fax to 1-877-513-5334

Web fillable: Complete the form online here, save and email to

Healthcare provider information

Patient/client information

If yes, the patient/client referral will be referred to Talk Tobacco, a free Canadian Cancer Society confidential program offering culturally appropriate support and information about quitting smoking, vaping and commercial tobacco use to First Nations, Inuit, Métis and urban Indigenous communities.

A Quit Coach usually calls within 3 business days. When should we call?

Time of day

Consent to contact: