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Request a Quitline call

Complete this form to request a call from one of our Quitline counsellors, who will give you advice and support to quit smoking. They can talk to you about the quit process, develop your own quit plan and help you quit for good.

You can nominate the best time and day for us to call, and let us know if you have any specific requirements.

It takes about 5 minutes to complete this form. Questions marked with an * must be answered.

Quitline is a confidential service. We do not pass on your details to anyone else.

More about quitting smoking.

    About you
    Your call details
    1. Please pick one timeframe a day only
    2. Optional questions
    3. Would you prefer a...
    4. Do you use the National Relay Service?
    5. Is a translator needed?
    6. (If you chose 'Yes' above)
    Background information
    1. Do you have any of the following health conditions?
    More information Is there anything else you would like to tell us?
Creative Commons Attribution 3.0 Australia (CC BY 3.0)
Last updated
7 July 2016

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