Hawaii Tobacco Quitline Materials Request Form

The Hawaii Tobacco Quitline has a variety of materials for health care professionals and educators. Materials are available free of charge. Please fill out the information below and your materials will be mailed to you. Please allow two weeks for delivery. For orders of 200 or more, please provide your phone information so that we can call to confirm your information.

First Name:*

Last Name:*

Company Name:

E-mail Address:*

Phone Number:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

Fields marked * are required. Please enter email address and phone number if possible, so we can contact you easily if necessary.

Please take a moment to answer the following questions so that we may better serve you.

Describe yourself:

Where or how will you use these materials? Check all that apply:

What do you find most helpful about the Quitline materials?

How can the Quitline's materials be more helpful?

Are there other materials you would like to see?

Material Requested

Fieldset 1

HTQL Business Size Card:

View PDF

Fieldset 2

HTQL User Brochure:

View PDF

Fieldset 3

HTQL Provider Brochure:

View PDF

Fieldset 4

HTQL 11"x17" Poster Set:

View PDF

(set includes 3 versions)

Fieldset 5

HTQL 11"x28" Poster Set:

View PDF

(set includes 3 versions)

What code is in the image?*

Copy the characters (respecting upper/lower case) from the image.

Quitting Is Hard. Now Helping Them Is Easy.

The Hawaii Tobacco Quitline is a free local service for anyone who lives in Hawaii who wants to quit smoking or using tobacco. This service is provided by a company that has been treating tobacco dependence with evidence -based methods for more than 20 years.

We realize that many people living in Hawaii do not have health insurance, others may have insurance that offers a quit tobacco program, and others may prefer to use a community program to help them quit. We work with everyone in Hawaii to find the best support for them or their loved ones – whether that is a local community class, a program offered by their health plan or the Hawaii Tobacco Quitline program.

If you would like to learn more about the Hawaii Tobacco Quitline and the services we provide, please feel free to call us at 1-800-QUIT-NOW. A specially trained Quit Coach will be happy to answer your questions. Additionally, we have a variety of materials for health care professionals and educators. If you would like to request any of these materials, fill out the form on this page.

Here's how it works

When a tobacco user enrolls in Hawaii Tobacco Quitline, a specially trained Quit Coach will use proven methods to help them:

Get ready to quit
Take action to quit
Stay quit

When they call, a Quit Coach will:

Assess their stage of readiness to quit
Help them set a Quit Date and create a Quit Plan
Schedule convenient times for follow up
Provide decision support for nicotine replacement therapy (NRT) like the patch, gum or medication like bupropion
Send stage-appropriate materials to help them stay on track between calls

How you can help

When you identify someone who uses tobacco and wants to quit, advise them to call 1-800-QUIT-NOW (784-8669) or visit www.QuitNowHawaii.org. We’ll take care of everything else. We’ll assess their readiness to quit, assist them in quitting and arrange for follow up contact.

If healthcare providers use the fax referral form, we’ll even report back the status of their patient’s quit attempt. Please be assured that the Hawaii Tobacco Quitline is completely HIPAA compliant.

Hawaii Tobacco Quitline Fax Referral Form

HIPAA Compliance Letter

Download our Marketing Kit (pdf)