Provider Web Referral For Patients Without NRT Contra-indications Complete the Provider Web Referral. You don’t need to print any pages.
eReferral For Providers Interested in using eReferral Please submit our Contact Us form to learn more about our eReferral program.
Fax referral For Patients With NRT Contra-indications If a patient has contra-indications to using NRT, please print, sign and return a Fax Referral form.