Ask your patients about smoking, refer them to QuitNow using the easy referral form, and let QuitNow do the rest.
Skylar Pepin, QuitNow Outreach Team Manager

Referral program

We make referring your patients to QuitNow's free quit smoking services easy.

There are 2 quick ways you can refer your patients

  1. Get access to our NEW online referral form. We will need your contact information to set it up but after that it is easy. Contact us at to set you up.
  2. Download our quit smoking service fax referral form*

*Order pads of 25 Referral Forms here. We ship them to you for free.

What does QuitNow do for your patient?

QuitNow has three types of support that may interest your patient. All the supports are included on the referral form (online or fax form). You can refer them to only one or all three. It is really up to the patient and what they prefer. At a glance you can help a patient decide what might work best for them

Patient Style Appropriate Service
Just want some information, and do it mostly on their own. QuitNow's Online Support has lots of great info and tools to help your patients quit in their own time and at their own pace. Patients have access to an interactive Quit Plan, a community forum of people who are quitting, and the ability ask questions of our coaches in real time through Expert Chat.
Need tips and motivation sent out to them. QuitNow's Text Support will send 3 months of motivational, personalized text messages directly to your patient's cellphone.
Need intensive guidance in developing a quit plan with a  trained Quit Coach. QuitNow's Phone Support includes up to 8 calls with a Quit Coach. The Coach will help your patient decide on the quit strategies that will be best for them and provide support up to 7-months after initial contact.