Request a call

RPCS currently offers quit smoking services to Roswell Park patients and employees and through programs sponsored by the following state Quitlines, health plans and employer:
  • Affinity Health Plan
  • BlueCross BlueShield of Western New York
  • BlueShield of Northeastern New York
  • Capital District Physicians' Health Plan (CDPHP)
  • EmblemHealth
  • Independent Health
  • New Jersey Quitline
  • New York State Smokers’ Quitline
  • Wegmans Food Inc.
To have a Quit Coach call you to see if you qualify for one of our programs, please fill out the following information.

Check all that apply:

Resident:



Health Plan:







Employee/Family of Employee:






I am a:





Name*:

 

Phone number*:

 

Preferred day of the week to be called:



Preferred time of day to be called:







Please note, fields marked with '*' are required to receive a call by a Quit Coach.