NSW Quitline Survey

For Healthcare Professionals Only

Question Title

* 1. Are you a:

Social worker

Dentist

General Practitioner

Nurse

Other (please specify)

Question Title

* 2. Which Primary Health Network do you belong to?

Central and Eastern Sydney

Northern Sydney

Western Sydney

Nepean Blue Mountains

South Western Sydney

South Eastern Sydney

Western NSW

Hunter New England and Central Coast

North Coast

Murrumbidgee

Unsure

Question Title

* 3. Have you heard of the NSW Quitline?

Yes

No

Question Title

* 4. Have you discussed quitting smoking with a client / patient this year?

Yes

No

Question Title

* 5. Have you made a referral to the NSW Quitline in the last year? i.e. completed a referral form for the Quitline

Yes

No