Smoking Review

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

Smoking Review

Smoking Review

Section

Smoking Review

What is your smoking status? *

Do not currently smoke section

How much did you smoke? *
When did you stop smoking? *

Do currently smoke section

How much do you smoke? *
Would you like to give up smoking? *

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

*
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