Smoking Review

If you have been advised by the surgery to submit a smoking review on a regular basis please use this form.

If you would like support to stop smoking please make an appointment with our Stop Smoking Team.

Smoking Review

Smoking Review

About You

Please use this date format: DD/MM/YYYY.

Smoking Review

Do not currently smoke section

Do currently smoke section

Please ask at reception for more information about giving up smoking.

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