• ACT Center Fax Referral Form
• Tobacco Medication Guide for Providers
• Tobacco Treatment Intake Form (TTIF)
• Brief Treatment Intake Form
• Brief Treatment Follow-Up Form
• Information about Tobacco Treatment Medications (Patient Handout)

To order the following forms, contact Chariece Thomas (ccthomas@ent.umsmed.edu):

• Therapist Clinic Guide
• Participant Manual
• Tear Sheet #1 - Session Summary + Tobacco Cessation Rating Scale
• Tear Sheet #2 - Medications Screening Form
• Tear Sheet #3 - Medications Recommendation Form
• Tear Sheet #4 - Treatment Satisfaction Form