Acknowledgment / Disclaimer
By checking the box below, the referring agency acknowledges that the client being referred consents to:
- Having their personal information shared with the BABY & ME-Tobacco Free Program (BMTFP), and
- Having their referral status communicated back to you as the referring agency, all of which is completed through a secure online referral system.
The National BMTFP Counselor will contact the client and offer enrollment into the program. The client’s contact information collected on this site will be kept strictly confidential and will not be sold, reused, rented, disclosed, or loaned. Clients’ personal information is contained behind secured networks and is only accessible by our BMTFP employees who have special access rights, and are required to keep all information confidential. I agree to the referral consent terms.