Skip to content

Brief Cessation Counseling

Do you know someone who wants to quit smoking/vaping? This online submission form was developed to help guide you through the 3 A’s of brief tobacco/vaping interventions. It should only take you 3 to 5 minutes to complete and make a referral (if appropriate). After your referral is received, a quit coach will reach out, usually within 2 business days.

If you have any questions about our Brief Cessation Counseling Form please email [email protected].