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.

Resources and Support for Providers

Get Trained: The MaineHealth Center for Tobacco Independence provides a variety of tobacco cessation trainings and education programs. Learn more.
Provider Tobacco Treatment Tools
Video Tools: Connecting Patients and Clients to the Maine QuitLink

Refer Clients to 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.

Watch Referral Tutorial Video

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.

Name (* Required):

Date of Birth (MM/DD/YYYY) (* Required):

Address (* Required):

Town (* Required):

State (* Required):

Zip (* Required):

Email (Recommended):

Phone (* Required):

What are the best times for the Maine QuitLink to call?:
MorningAfternoonNo Preference

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

I consent to receiving text/SMS messages from Maine QuitLink.
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Please leave this field empty.