Request a Quitline call

Help to quit for good

Fill in this form and one of our Quitline team will call you back. They can talk to you about ways to quit and help find a plan that works for you. It's completely free and they won't tell anyone about your call.

Given name *

Family name *

Date of birth

What is your sex?

Female
Male
Other

Suburb *

Phone number *

Is it ok to leave a message, if we don't get through? *

Preferred contact date *

Preferred contact time *

Do you identify as being of Aboriginal and Torres Strait Islander origin?

Would you prefer to speak to an Aboriginal or Torres Strait Islander counsellor?

Do you require an interpreter?

What language?

What prompted you to request a call today?

Other

Anything else you want to tell us about your smoking, vaping, health, or call request?

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

Last updated: April 2025