Smoking Review

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

Smoking Cessation

If you smoke and wish to stop please contact the surgery to make an appointment with our Smoking Cessation Advisor. They can offer support and recommend suitable smoking cessation therapy (e.g. patches, tablets, gum) to help you quit. This can be prescribed by the surgery

Alternatively a doctor or nurse practitioner can provide nicotine replacement therapy or other medication to help you stop. Please ask for an appointment with your Doctor or nurse practitioner.

There is also free advice available at Quit Now – Smokefree and 0800 022 4332.

Smoking Review

Smoking Review

About You

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Smoking Review

Do not currently smoke section

Do currently smoke section