Directory of resources for tobacco control in New Jersey and materials to assist patients in becoming smoke free. Fax to quit forms are available to download for easy referral to free cessation services.
Proactive referral to the New Jersey Quitline and MQC for Families; New Jersey’s free smoking cessation programs. When the referral is received, a quit coach will contact provider's client, immediately. This is an excellent tool to assist providers with the Ask, Advise, Refer: Brief Intervention Model. Utilizing the fax-to-quit referral form generates a provider feedback report from the NJ Quitline and/or MQC for Families for client follow up. Registering for your personalized fax-to-quit referral form generates a provider partnership with Tobacco Free for a Healthy New Jersey for periodic updates and program announcements.
For personalized fax forms e-mail firstname.lastname@example.org
Fax-to-Quit Referral Program
Mom’s Quit Connection (MQC) for Families and the NJ Quitline has developed a provider toolkit to assist New Jersey health care professionals in providing effective interventions for tobacco cessation during patient and client interactions. Navigating the online toolkit will provide healthcare professionals the opportunity to learn about the services and resources these programs offer.
For inquires; contact .
Tobacco Cessation Toolkit for Providers
Mom’s Quit Connection for Families
Mom's Quit Connection (MQC) and MQC for Families have current and updated, preprinted and downloadable brochures, posters, quit cards and other assets available. Please contact us for information of available support assets.
For inquires; email@example.com.
Below is a 15 minute educational video highlighting New Jersey’s free and effective smoking cession program for pregnant women and their families.
Click here to order the video.
NJ Quitline is a free telephone-counseling service for smokers who are ready to stop.
A trained Quit Coach who has years of counseling experience will listen – without judgment – and help to create a plan for quitting, including how to cope with cravings and ways to avoid slips and relapse.
Quit Coach Hours: 24 hours/7 days a week
Number of attempts per year: 3
Fax-to-Quit from provider;
Toll free 1-866-NJ STOPS;
Nicotine patches available for eligible callers.
New Jersey Quitline
The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 provides an overview of the full report of the Surgeon General and highlights the conclusions and findings of the devastating consequences of 50 years of tobacco use in the United States.
Center of Disease Control & Prevention
Download free patient education and promotional materials from the Center for Disease Control’s national Tips From Former Smokers Campaign.
Health Care Professionals: Help Your Patients Quit Smoking guides to help implement strategies to assess and address tobacco use among your patients and clients.
American Academy of Pediatrics
American Academy of Pediatrics educate and equip pediatricians, other physicians, and non-physician clinicians to prevent, treat, and reduce exposure to tobacco and secondhand smoke.
Download the blank NJQL fax-to-quit Referral Forms to be used immediately.
Download the blank MQC fax-to-quit Referral Forms to be used immediately.