Quitline is a free confidential support service for people who want to quit smoking.
Clients should consent to receiving a call from Quitline prior to this form being completed.
To refer a client to Quitline, complete the online referral below.
Or, you can download and print the Quitline referral form (PDF 299 kB)
Smoke-free pregnancy
Queensland Health provides a free, tailored quit smoking cessation program for pregnant women, their partners and women who are planning a pregnancy within the next 6 months. The program is delivered by the Quitline service.
The ‘Quit for You…Quit for Baby’ program provides multiple support calls and 12 weeks support of nicotine replacement therapy.
Clients should consent to receiving a call from Quitline prior to this form being completed.
To refer a client to the program, complete the online referral form below.
Or you can download and print the Quit for You…Quit for Baby referral form (PDF 295 kB).
Privacy notice
Personal information, including sensitive information, collected by the Department of Health is handled in accordance with the Information Privacy Act 2009. The purpose of this form is so that patients may be referred to the Quitline service for information, advice and assistance. All personal information will be securely stored and only accessible by authorised officers of the department. Demographical information, such as gender, age group, suburb and cultural background may be used for our statistics, but will not include any identifiable information. Personal information will not be disclosed to third parties without consent, unless required or authorised by law. For further information, including an individual's right to access their own personal information, please refer to our privacy policy.
