Get your patient connected.


Connects the patient and the services directly so you can rest assured they are receiving guidance. Plus, it allows the QuitLine to inform the provider about the patient’s progress.

Fax Referral Form

Electronic Health Record

  • Simplest way
  • Patient information sent directly to QuitLine for enrollment
  • Available at several healthcare facilities
  • See resources section of QuitLine PROF training for more information


Helps a patient get connected, but leaves the provider unsure if patient follows through.

Phone: 1.866.SD-QUITS

  • Call the QuitLine with your patient
  • Give them a QuitLine business card or brochure. These are available to order through the DOH online catalog. Order online

Web Referral:

  • Patient fills out form on their own
  • QuitLine calls back by the next day to enroll them