Referral Form

If you want to quit smoking, you do not need a doctor to provide a referral to Nopuff Clinic for you. However, if you are concerned about your medical history, simply take the below form to your doctor, who will be able to help you fill it out.

If you are a health professional and would like to refer a patient to Nopuff Smoker’s Clinic, please download and complete the following form:

Nopuff Smokers’ Clinic – Referral Form