Refer Patients

Refer Patients

Free Phone Counseling: Utah Tobacco Quit Line

Utah Tobacco Quit Line Fact Sheet

Utah Tobacco Quit Line Fax Referral Form

Utah Tobacco Quit Line Spanish Fax Referral Form

Utah Tobacco Quit Line Online Referral Form



Some people are uncomfortable initiating contact with the Quit Line and others simply lose the phone number before they have an opportunity to call. Now, clinicians can directly refer clients using the Utah Tobacco Quit Line Fax Referral System. The Utah Tobacco Quit Line proactively calls your clients to help them quit.


  1. Download the Fax Referral Form.
  2. Print the form and photocopy it. Make enough copies for each of your tobacco-using clients to have their own form.
  3. Ask your tobacco-using clients if they would like the Utah Tobacco Quit Line to help them quit. If a client would like help, write your name on the form and ask the client to fill out the rest of the form. The client must sign the form or, if the client is a minor, the client’s guardian must sign the form. If the client does not want to fill out the form, give the patient the Quit Line’s toll-free telephone number 1.800.QUIT.NOW (1-800-784-8669) or offer a Utah Tobacco Quit Line card so that the client can contact the Quit Line when they are ready. Do not pressure clients to fill out the form if they do not want to.
  4. When the client finishes filling out the form, verify that all items are filled in, that the handwriting is legible and that the mandatory signature is present.
  5. Fax the form to the Utah Tobacco Quit Line’s toll-free fax number:1-800-483-3076.


For online referrals, click here and complete the form to refer your patient using the electronic referral system.


The Utah Tobacco Quit Line calls the client to help them quit using tobacco. The Quit Line will begin making attempts to reach the client starting within one business day of the referral. The support and counseling services that your clients receive depend on their preferences and their eligibility.

The Utah Tobacco Quit Line faxes your clinic so that you know when your patient received services. This information is useful for the patient’s health record and to facilitate follow-up with the patient.

More information on the Utah Tobacco Quit Line can be found here.

Free Online Counseling: Utah Quit Now

Online Coaching is a free, internet-based service designed to help individual tobacco users through the quitting process. Its interactive tools and features can be used 24 hours a day, seven days a week, for as long as needed. At any time, tobacco users can log on for information and support.  Utah online coaching members can take advantage of:

  • Tools to help them through the quitting process
  • Smoking cessation tips and answers to frequently asked questions
  • Access to medication guides
  • Interaction with quitting experts

All these services are free to Utah users. Online coaching can be used alone or in combination with other services, like the Utah Tobacco Quit Line, for added support.


Content updated: June 2016.
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