Social Service Provider Referrals

As a social service provider, you are a trusted resource for your clients who are asking about tobacco use. You can increase their odds of successfully quitting tobacco or vaping by providing a brief intervention and connecting clients to evidence-based tobacco treatment, like the Maine QuitLink.

Please complete this form to connect your client to the Maine QuitLink. They will receive a call from a Quit Coach with more information and have the opportunity to enroll in the free Maine QuitLink program.

Additional resources and support is available for providers:

  • Get Trained: The MaineHealth Center for Tobacco Independence provides a variety of tobacco cessation trainings and education programs for providers and clinical staff throughout the state of Maine. Learn more.
  • Provider Tobacco Treatment Tools

This request is for:

MyselfSomeone Else

Describe Your Role:
Please make sure you have the permission of the individual whose information is being submitted as the HelpLine does need to speak with that individual directly.

Please specify:

Name (* Required):

Address (* Required):

Town (* Required):

State (* Required):

Zip (* Required):

Email (Recommended):

Phone (* Required):

What are the best times for the Maine QuitLink to call?:
8am - 12pm12pm - 3pm3pm - 6pm6pm - 8pm

Is it ok to leave a message at this number?:

Verify Characters: