Referring Professional Information

Patient/Client Information


Patient/Client Consent


Patient/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.


Verify



Major funding provided by the California Department of Public Health & First 5 California.Copyright © 2021. 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 © 2021. The Regents of the University of California. All Rights Reserved.