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Referral programsReferring patients is simple

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Patient Referral Programs

Nicotine Gum Giveaway - Help needed to get the word out!

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Patient referral programs –

Our patient referral program is designed to be an adjunct to healthcare providers' efforts to help their patients stop smoking. It ensures stop-smoking support is readily available to patients following their healthcare visit.

Direct referral options:

Online referral site

HIPPA-compliant and password-protected application for directly referring patients.

The site offers aggregated reporting and individual patient activity reports.

Refer online

Fax referrals

Healthcare providers have access to a health-site customized fax referral form to refer patients to the Quitline.

Faxed progress reports are sent twice per month.

Referral form
Progress report (sample)

Enterprise solutions in Opt-to-Quit

Our Opt-to-Quit referral program offers a healthcare system-wide solution that ensures every tobacco-using patient is offered a referral to the Quitline.

More than 750 healthcare sites throughout New York State use our successful Patient Referral Program.

Patient referrals can be electronically transferred and patient activity reports are available online.

For more information about Opt-to-Quit™ or any of our patient referral options, please contact us.

Opt-to-Quit Materials

Program Highlight | Stony Brook Children's Hospital & Opt-to-Quit

(Above) "Smoking Cessation and Breastfeeding: Good for Your Baby, Good for You," stonybrookchildrens, YouTube. Featuring Physician Task Force member and NYSSQL featured expert, Dr. Rachel Boykan, MD, FAAP
Opt-to-Quit™ and Stony Brook Children's Hospital partner to educate and improve family health with tobacco cessation support and guidance.

Research article, Stony Brook and Opt-to-Quit™

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 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 stop-smoking medication coverage.

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

Program testimonials

Mary M

Mary Miller, 68, with her dog, Buffy at her home in West Seneca, near Buffalo, NY.

Patient Referral Success

THE BUFFALO NEWS – "A widow’s best advice to those who smoke? Quit."
Mary M. of West Seneca, NY – a smoker for nearly 50 years and recently diagnosed with COPD – is now living a smoke-free life, thanks to a referral by her healthcare provider to the New York State Smokers’ Quitline.

Learn more about — Mary’s story

Physician Testimonial

Dan Croft, MD, MPH, a member of the New York State Smokers’ Quitline Physician Task Force, explains the value of patient referral programs.

Learn more about — Our expert panel

To learn more about the program or to get started - Contact us
Last updated 8/13/2020 8:00 AM
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Not insured? Check out the New York State of Health by visiting nystateofhealth.ny.gov.

Developed by Roswell Park Cessation Services at Roswell Park Comprehensive Cancer Center | Elm & Carlton Streets | Buffalo, NY | 1-866-NY-QUITS (1-866-697-8487) | nysmokefree.com | Call hours: Mon-Thurs 9AM-9PM, Fri-Sun 9AM-5PM. Deaf, Hard of Hearing and Speech Disabled: Call the NY Relay Service at 7-1-1 (Voice or TTY), give the operator the Quitline number. | Privacy | *Logo cannot be reproduced without permission.

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