These forms are for health care providers and pharmacists who want to refer their smoking patient to the I QUIT NOW services. The patient should receive a phone call in 1 or 2 business days after you have submitted the form. The smoking cessation specialists working at the I QUIT NOW quitline will be receiving all completed forms and will present all I QUIT NOW services to the patient:

- Telephone support offered by the I QUIT NOW quitline

- Online support offered by the I QUIT NOW website

- In-person support offered by the Quit Smoking Centres of their region

- Text message support offered by the SMAT.


Patient reference form from pharmacies
Patient reference form from health facilities


Titre affiché
Referral form
(for Quebec Health Care Providers only)