Referring Professional Information

Client Information


Client Consent


Client or Guardian (if under 18) consents to allow the referring organization to share contact information with Kick It California for the purpose of offering cessation services through phone or email.


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Major funding provided by the California Department of Public Health & First 5 California.Copyright © 2023. The Regents of the University of California. All Rights Reserved.
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Major funding provided by the California Department of Public Health & First 5 California.
Copyright © 2023. The Regents of the University of California. All Rights Reserved.