Request a call

Roswell Park Cessation Services provides evidence-based, best practice telephone and web-based services for the following health plans, state quitlines, and employer-sponsored programs:
  • Affinity Health Plan
  • BlueCross BlueShield of Western New York
  • BlueShield of Northeastern New York
  • Capital District Physicians' Health Plan (CDPHP)
  • EmblemHealth
  • Independent Health
  • New York State Smokers’ Quitline
  • Roswell Park Comprehensive Cancer Center
  • 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 and select 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.