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NSW Quitline Survey
For Healthcare Professionals Only
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1.
Are you a:
(Required.)
Social worker
Dentist
General Practitioner
Nurse
Other (please specify)
*
2.
Which Primary Health Network do you belong to?
(Required.)
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
*
3.
Have you heard of the NSW Quitline?
(Required.)
Yes
No
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4.
Have you discussed quitting smoking with a client / patient this year?
(Required.)
Yes
No
*
5.
Have you made a referral to the NSW Quitline in the last year? i.e. completed a referral form for the Quitline
(Required.)
Yes
No
Current Progress,
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