Download the Fax Referral Form or the Fax Referral Program Information Sheet. 

What is Fax Referral?

Fax Referral is a program that builds on the services Alaska’s Tobacco Quit Line offers by creating partnerships with healthcare providers. Through the Fax Referral Program, tobacco users no longer have to take the first step by calling the Quit Line; instead, after talking with their clinician, they can agree to have the Quit Line call them.

How Does it Work?

Tobacco users who would like to make a quit attempt in the next 30 days can sign a Fax Referral enrollment form during a face-to-face intervention at a doctor’s office, hospital, dentist’s office, clinic or agency site. The form is then faxed to the Quit Line. Within 48 hours, a quit coach makes the initial call to the tobacco user to begin the intervention.

Why is it Beneficial?

• Seizing the Moment. Fax Referral connects tobacco users with the Quit Line right from the doctor’s office. Since the Quit Line initiates the first call, the responsibility is not on the tobacco user to begin services. Therefore increasing the chances of a quit attempt.
• It Saves Time. Many doctors, nurses, dentists and other healthcare providers may not have time to offer comprehensive tobacco treatment. Fax Referral allows them to refer their patients to the Quit Line for specialized coaching based on years of scientific research. 
• Not Lost in Translation. The tobacco user can identify his or her primary language on the enrollment form and a Quit Line translator will be on the line when the quit coach places the call. Quit Line services are available in many languages spoken throughout Alaska.