Smoking Review

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

NHS Stop Smoking Services

Local stop smoking services are free, friendly and can massively boost your chances of quitting for good. Their services staffed by expert advisers provide a range of proven methods to help you quit.

Website: NHS: Stop Smoking Services

Smoking Review

Smoking Review

Smoking Review

Do you currently smoke?

Do not currently smoke section

Have you smoked in the past?
How many cigarettes did you smoke in a day?

Do currently smoke section

How many cigarettes do you smoke in a day?
Would you like to give up smoking?

You will be contacted for an appointment with a smoking cessation advisor.

Please upload any information relevant to your smoking review.
Maximum upload size: 67.11MB