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Do you smoke and want to quit smoking?
Do you smoke and want to quit smoking?
Complete this quick form to enlist Doctor (GP) prescribed help to quit smoking.
Quit Health Evaluation Form
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    Click 'NEXT' to agree you understand QUIT.HEALTH and start the process.
    How QUIT.HEALTH Quit smoking works.
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  • 9
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  • 10
    if any of the following apply to you, you cannot proceed with this service.
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  • 11
    The probability of success in quitting smoking increases when you enlist help. It is essential to our program that you sign up to one of the following FREE public smoking cessation supports. Tick one and we will send you sign up information
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  • 12
    How would you like to collect your prescribed medication? You will be invoiced after the Doctor prescribes. $6.60 per month for concession card holders and $41.30 per month for medicare card holders.
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  • 13
    Your digital consultation will be conducted today by our GP Doctor who will review your digital answers and may contact you or the pharmacy directly should he require further clarification. All your answers are stored in a secure and encrypted environment and are kept completely confidential. Please acknowledge you are happy for our GP Doctor to review any information provided by signing below.
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  • 14
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    ORDER SUMMARY
    Total costAUD
    • Quit Health Smoking Cessation Prescription
      Quit Health Smoking Cessation PrescriptionQuit Health Smoking Cessation Prescription. Prescription only. Medication is on the Pharmaceutical benefits scheme. $6.60 per month concession card holders. $41.30 for Medicare card holders.
      $34.99AUD+Edit
      Back
      Total cost $0.00AUD
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    • 15

      Please click one of the PayPal options to complete payment and submit the form.

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