Smoking Cessation E-Newsletter Survey Question Title * 1. What barriers do you experience when referring patients to clinic- or community-based tobacco cessation resources? (Check all the apply.) Unaware of programs and services available. Lack of resources that meet the needs of my patients. Lack of evidence based programs available. Lack of time during patient visits to make referrals. Lack of a referral system or mechanism. Lack of someone to make the referral. Lack of a database or directory of clinic-based or community-based resources. Lack of patient/family interest and cooperation. Other (please specify) Question Title * 2. Does your practice currently refer patients to the Illinois Tobacco Quitline by using the fax referral form? Yes No Question Title * 3. Does your practice have a policy in place to incorporate the 5 A's of smoking cessation (ASK, ADVISE, ASSESS, ASSIST, ARRANGE)? Yes No Done