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Ontario Drug Benefit Pharmacist Smoking Cessation Program Forms:


Readiness Assessment

First Quit Consultation Meeting – My Quit Plan

Primary Follow-up Counselling Sessions 1-3

Secondary Follow-up Counselling Sessions 4-7

Program Evaluation

Fax Referral Form Quit Connection

Ottawa Model For Smoking Cessation:

Ottawa Model Quit Counsel Form

Health Connect Ontario Smoking Cessation Program::

Smokers’ Helpline – Health Connect Ontario referral form