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I'm here because...
I'm here because...
I'm thinking about quitting
I'm ready to work out how to quit
I need help to stay on track
I'm smoking again
I'm helping someone I know quit
Tools & Resources
Tools & Resources
Build your quit plan
Calculate the cost of smoking
Effects of smoking on your body
Distract me
Tips & tactics
Ex-smokers' stories
Fact sheets
E-cigarettes
Get Support
Get Support
Request a call back
Sign up to QuitMail
Sign up to QuitTxt
Sign up to QuitCoach
News & Advocacy
News & Advocacy
Facts & evidence
Policy & advocacy
News & media releases
For Health Professionals
For Health Professionals
Resources for health professsionals
Quit education & training
Smoking cessation guidelines
Resource order form
Subscribe to our newsletter
Refer a patient to the Quitline using the Smoking Cessation referral form
Quitline referral
For Communities & Places
For Communities & Places
Resources for communities & places
Community health promotion workforce discussion forum
Resource order form
Subscribe to our Communities & Places newsletter
Map of Smokefree Victoria
Home
Current:
Quitline referral form
Quitline referral form
You can fill out the form below
or complete the
PDF here
and send it via fax on 1800 931 739
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