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Indiana Tobacco Quitline 1-800-QUIT-NOW

Quitline > Become a Preferred Provider Become a Preferred Provider

The free Quit Now Preferred Provider Program- developed by Indiana Tobacco Prevention and Cessation (ITPC)- gives healthcare providers proven, professional resources to help patients/clients kick their addiction to tobacco.

As a Preferred Health Care Provider with the Quit Now Referral Network, you will receive exclusive tobacco cessation services and materials, including:

  • Fax Referral Privileges to the Indiana Tobacco Quitline, which offers specially trained Quit Coaches to develop individualized quit plans for people who are ready to quit.
  • Referral Kit, which includes:
    • Fax referral forms
    • Indiana Tobacco Quitline brochures
    • Tobacco resource guide, with pharmacotherapy chart and insurance reimbursement codes
    • Tobacco cessation counseling materials
  • Status reports on fax referred patients, letting you know whether or not the patient was reached, enrolled in services and planned a quit date
  • Immediate access to professional evidence-based resources
  • Ongoing communications on the latest research, tobacco news in Indiana and resources available to Preferred Providers
  • Direct access to ITPC’s cessation specialists for additional advice and consultation

Your patients look to you for direction about their individual health issues.  Your help and guidance can give them the power to curb their tobacco addiction.  For patients who are ready to quit using tobacco, fax referring them to the Indiana Tobacco Quitline is the right first step.

The fax referral system is quick & efficient:

  • Provides intensive counseling options often not feasible in busy clinic environment
  • Easy to use form
  • Initial call made by Quit Coach™ instead of tobacco user
  • Outcomes reported back to physician/clinic

Enroll today and begin referring patients to the Indiana Tobacco Quitline immediately. 

Enrollment as a Quit Now Preferred Provider is quick and simple.  There is no charge for this service.

To download a PDF of the enrollment form and fax your information to 317-234-1786, click here

To complete the on-line enrollment form, please complete the registration below and submit your information.

Required Field Required

Required Field Individual Provider's Name

Required Field Practice or Organization Name

Required Field Type of Practice or Organization

Mailing Address

City

State

Zip

County

Required Field Email Address

Required Field Phone Number

Fax Number

Verification Code

We look forward to working with you.