Abstract Background. Only recently have clinical programs for smoking cessation become available in some medical centers. Counselor intervention services are provided to Mayo patients, most of whom are physician referred. Each patient receives a 45- to 60-min consultation and then is enrolled in a structured follow-up/relapse prevention program. Methods. In 1989, 224 of 1764 patients referred by their physicians for consultation did not receive the consultation. This cohort was surveyed 1 year after referral to determine smoking status. We compared these patients to a cohort of 578 patients who were seen in 1988 for counseling and received the follow-up program. Results. Of those referred, 87.3% received consultation. There was a 10.7%, 1-year point prevalence self-reported smoking cessation rate for those who were referred but did not follow through compared with 23.0% for those seen by the counselor and who received the follow-up program. Conclusions. In a medical setting, physician referral for nicotine dependence intervention and counselor-provided services is associated with a high attendance rate. Receiving counselor-provided consultation and follow-up was associated with a doubling of the stop rate. Such counselor services have substantial utility. There is a need for broader implementation of this type of service in medical centers.