Search by Keyword

1-866-QUIT-YES 1-866-784-8937

Give Me a Call

Referral Forms

Become a Quitline Referral Partner

What is the Illinois Tobacco Quitline?

The Illinois Tobacco Quitline (ITQL) is a free telephone resource that provides tobacco-cessation counseling and information to tobacco users who want to quit tobacco use, and tobacco-cessation materials to individuals requesting information to give to a tobacco user. Nicotine replacement therapy (NRT), including nicotine patches, gum or lozenges, may be recommended in combination with cessation counseling and is made available to eligible ITQL callers through the Illinois Department of Public Health, statewide NRT distribution program. In addition to telephone counseling services, the ITQL offers web-based services including general information on the ITQL, responses to information requests about tobacco cessation, online interactive counseling and email referrals and requests for a call from an ITQL counselor.

The ITQL is staffed by tobacco-treatment specialists, registered nurses, and respiratory therapists who have received training in tobacco-cessation counseling.  Both English- and Spanish-speaking counselors are available on the ITQL staff.  For callers who speak other languages, an interpretation service with access to more than 200 other languages is used. Business hours are 7AM to 11PM, daily, and messages received outside of business hours are returned within 24 hours. The ITQL is funded by the Illinois Department of Public Health and managed by the American Lung Association in Illinois.

Why should I become a Quitline Referral Partner?

National recommended best practices, including the Clinical Practice Guideline: Treating Tobacco Use and Dependence (2008), indicate that tobacco users are more likely to attempt quitting tobacco if a healthcare provider recommends quitting and refers the patient for cessation treatment. All tobacco users should receive advice to quit and should be offered brief or more intensive counseling services (in person or via a quitline) and FDA-approved cessation medication, if indicated. Telephone quitlines have been shown to be effective in providing wide access to evidence-based cessation counseling. Healthcare providers and systems can take advantage of the availability of ITQL services by implementing a system that regularly refers patients to the ITQL through electronic or fax referrals. As an ITQL referral partner, a healthcare provider will be able to easily, quickly and effectively refer patients who are tobacco users for cessation counseling and support. Through the ITQL tracking system, providers will be able to obtain information about their patients who receive cessation counseling through the ITQL. 

How do I become a Quitline Referral Partner?

Any healthcare provider, facility or system that provides healthcare services to tobacco users may enroll as a Quitline Referral Partner. Providers who wish to enroll should contact their local health department or the ITQL for additional information and assistance in enrolling. After the healthcare provider has been enrolled as a Quitline Referral Partner, training on integrating the referral process into clinical practice and necessary referral forms will be provided by the ITQL.   

Getting Started as a Quitline Referral Partner

How do I determine if a patient should be referred?

During each office visit with a patient who uses tobacco products, a healthcare provider should use a brief tobacco intervention, such as the 5A’s (Ask, Advise, Assess, Assist, Arrange) or Ask, Advise, Refer, to determine a patient’s smoking status and readiness to quit. If the patient is contemplating quitting or is ready to quit, the provider should complete the Illinois Tobacco Quitline (ITQL) Tobacco Treatment Enrollment Form and submit it to the ITQL by the method specified in the healthcare provider’s Quitline referral agreement. 

Prior to implementation of the Quitline referral program in a healthcare facility, the ITQL team will provide training to staff who will be involved in the referral process. The training will cover completion and submission of the Tobacco Treatment Enrollment Form, brief tobacco interventions and additional skills for talking to patients about tobacco use.

How do I submit a referral?

Referrals to the ITQL may be submitted by one of the following three methods, fax, electronic fax (e-fax) or electronic medical record (EMR) data transfer, as specified in the provider’s Quitline referral agreement.  A healthcare provider enrolled for referrals using either fax or electronic fax will transmit referral information to the ITQL via fax, email fax or electronically through the ITQL website at  The ITQL will provide each new referral partner with an individualized Tobacco Treatment Enrollment Form containing the provider’s organization logo and a provider identification number that will be scanned electronically by the ITQL for data collection purposes. A healthcare provider enrolled as a Quitline Referral Partner using EMR data transfer will complete and transfer all referral information to the ITQL through the EMR system.

When completing a referral to the ITQL, the provider must obtain the signature of the patient or patient’s representative as authorization for the provider to release information on the enrollment form to the ITQL.   Without a signature, the ITQL will not be authorized to contact the patient. 

Are you able to track how many referrals my office submits?

Use of the provider identification number will enable the ITQL to track referrals accurately for individual providers.  Providers will be able to access data and reports for their practice.