Aboriginal Quitline Referral Form

Using a service like Quitline can greatly increase a person’s chance of quitting successfully.

To refer a patient or client to Quitline, simply complete the Referral Form below or download the Quitline Referral Form. Download

For further information email admin@quittas.org.au or phone (03) 6169 1943.

Aboriginal Quitline Referral

  • Referring organisation

  • Client Details

  • (eg: ATSI status, health concerns, pregnancy, etc)
  • The above question is for testing whether you are a human visitor and to prevent automated spam submissions.