Smoking Review

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

We welcome your feedback, if you have feedback or compliments please visit the Feedback page.

If you have a complaint please do so in writing to the practice manager or complete a complaints form which you can obtain from the practice reception.

Please do not use this form for complaints.

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?

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