Smoking Review

Please complete the following form to confirm your smoking status and/or if you would like help to stop smoking. If you do wish to stop smoking we have a Smoking Cessation Advisor and she will contact you and to arrange an appointment that is convenient to you.

Smoking Review

Smoking Review

Section

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?
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