Fax to Quit Program

A Service of the PA Free Quitline

What is Fax to Quit?

The Fax To Quit Program allows healthcare and non-healthcare professionals to refer tobacco-using individuals to PA Free Quitline services for expert, evidence-based and confidential coaching to become tobacco-free.

How Fax to Quit Works

  • Conduct a brief intervention to determine the individual's readiness to quit tobacco
  • Fill out the Fax to Quit referral form to enroll in Quitline services
  • Fax the Referral Form to PA Free Quitline for contact within 48 hours
  • Receive confirmation of contact and Fax-back Reports on patient progress (HIPAA-covered entities only)


Benefits To You

  • Increases likelihood of successfully quitting
  • Integrates Quitline into treatment plan
  • Provides  faxed patient progress reports to HIPAA covered entities only
  • Provides participant support when needed most, 24 hours a day
  • Continuing Medical Education (CME) credits

Studies show that using brief intervention, along with phone counseling and medication, greatly increases the odds of successfully quitting tobacco.

Benefits to the Participant

  • Coaching available 7 days per week
  • Up to 5 proactive coaching sessions with unlimited inbound calls
  • Assessment  with personalized feedback to enhance motivation and commitment
  • Review of quit plan and quit date
  • Education on use of approved or prescribed quit smoking medicine
  • Nicotine replacement therapy for eligible participants if available
  • Self-help quit guide and tailored fact sheets by mail
  • Also effective for spit tobacco users
  • Quitline services available in the English, Spanish and other languages

    How to Get Involved

View the Fax to Quit Brochure

For additional information, contact the Department of Health Regional Primary Contactor in your area.