California Smokers' Helpline: 1-800-NO-BUTTS

Refer a Patient or Client

Simply complete steps 1, 2, and 3 below for each patient you refer, and click "Submit" or “Refer Another Patient.” Once the information is received, a Helpline representative will make five attempts to call the patient over one week.

Click the following links to download a printable copy of the referral form in English or in Spanish

1. Health Professional Information
2. Patient Information
 
 

 
3. Patient Consent