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Quitline referral

You can fill out the form below or complete the PDF here and send it via fax on 1800 931 739

Need to refer a patient?

Refer a patient to the Quitline using the Smoking Cessation referral form.

You can also complete the PDF and send it via fax to 1800 931 739.

Other useful resources

Quitline Referral Form for Health Professionals | Quit