Welcome to the Arkansas Tobacco Quitline Referral Program. You have indicated
you are not a HIPAA covered entity so the Quitline will not be able to share service
outcome information with you as a provider. If this is not the case, please utilize
the registration application in order to log back in to view service outcome information.
Otherwise, proceed with the form below. Thank you!
Please provide information about your Healthcare Organization.
If you have questions about how to use this form, call 1-800-Quit-Now.