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

Refer your clientsto QuitNow, and we'll take it from there. Your patient will receive a call or email within a matter of days, and our professional Quit Coaches will walk them through everything they need to know.

There are two ways to refer your clients to QuitNow:

  1. Use our online referal form. In order to get set up with your own access, contact us at  with subject line "Referral Form".
  2. Download our quit smoking service fax referral form

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