Referral Programs

Referring patients is
simple

Get Started

Support to quit or cut back on commercial tobacco products is readily available to patients following their healthcare visit.
Choose from online or fax patient referral options, sign up, learn more, or get help!

Refer my patient/client
New Physicans/Groups
What to expect
Help/Support

Online Referrals

HIPAA-compliant, secure online form for directly referring patients.

If requested, patient/client progress reports are sent monthly.

Refer my patient online

Fax Referrals

Complete our HIPAA-compliant, secure online form and select “fax” to submit, or print the form and fill it out, then just fax it to the NYS Quitline!

If requested, patient/client progress reports are sent monthly.

Refer my patient by fax

Print Form

What to Expect

We prepare your patients for success

Once you refer a patient, a Quit Coach will call your patient within 48 hours of receiving your referral and offer NYS Quitline services.

Individualized coaching will help motivate a quit attempt, prepare for the quit process, and avoid future relapse.

Medication supply and coverage

Eligible patients will be offered a supply of nicotine replacement therapy (NRT). All patients will be advised to learn about their health plan cessation benefits, including medication coverage.

Patients will also be informed of additional support, like health plans and local programs, websites, and self-help materials.

Sign up

Help and feedback

Whether you need help with your patient referrals, you have ideas about how we can improve the program, or you like it just the way it is – we want to hear from you!

Having an issue with your referrals? Let us help.

Report an Issue

If you’re not quite sure how to use something, or you just have a question about the Patient Referral Program? Let us help.

Contact Our Team

Reports are shared monthly or by request. Please keep in mind that custom reports may be limited and that requests for new report schedules/frequency and the data received will be subject to review/approval.

Report Inquiry

Just a moment of your time makes a difference!

Take our survey
smiling associate with a headset and laptop

Success Stories

The Quitline was available as a resource whenever I felt like I was struggling during my quit-journey. -Crystal G.
There was no judgment at all whatsoever, and their non-cookie-cutter approach was the key to my success. -Mark L.
With the Quitline, I feel like someone’s rooting for me. -Gabrielle S.
Their new texting program [Learn2QuitNY] was an ultimate help for me. The texts reminded me to keep trying. -Herman L.
The Quit Coaches at the Quitline helped me succeed – they motivated me and said, ‘You can do this.’ -Leanna K.
When my wife and I learned we would become parents, that gave me the final push to become nicotine-free. -Sholom G.
The follow-up calls and just knowing support was always there if I needed it – that was so helpful. -Marielle F.
The Quitline has always been enormously helpful, and I continue to call back to thank the Quit Coaches and let them know how many weeks I’ve been tobacco-free. -Michael F.
This service is unmatched, but having someone genuinely helping, someone you know is talking you through a craving. It is a god-send! -Anonymous