You may click on these to open in your browser or right click and save the linked file to your desktop.

Ontario Drug Benefit Pharmacist Smoking Cessation Program Forms:

FAQ

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